The Impact of Learning Spaces in Undergraduate Dental Education: A Scoping Review

The Impact of Learning Spaces in Undergraduate Dental Education: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Learning Spaces in Undergraduate Dental Education: A Scoping Review Siobhán M Lucey, Katie Power, Briony Supple, Francis M Burke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7723267/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Learning spaces have been defined as physical or virtual spaces in which learning and practice occur. Clinical dental education may take place in a variety of settings, including open and closed surgeries in teaching hospitals, health centres and dental practices. The aim of this scoping review is to map available evidence regarding the impact of learning spaces on undergraduate dental professional students during their clinical training. The secondary objectives are to ascertain how learning spaces in undergraduate dental education are evaluated, to identify potential gaps in knowledge, and to inform future primary research. Methods This scoping review was conducted in accordance with Joanna Briggs Institute guidance and the PRISMA Extension for Scoping Reviews. An a priori protocol was developed and registered on the Open Science Framework. The research questions and eligibility criteria were designed using the Population (undergraduate dental professional students), Concept (impact and evaluation of learning spaces), Context (clinical training in physical/virtual environments) Framework. A comprehensive database and grey literature search strategy was developed. Key journals were hand searched and important authors were contacted. Source selection was carried out independently by two reviewers screening titles and abstracts, facilitated by Rayyan, followed by full-text screening of potentially relevant articles. Data was extracted using a structured proforma and summarised descriptively. Results In total, 2,286 records were identified following deployment of the search strategy. After de-duplication and exclusions, 22 full-text sources were identified for inclusion. Most studies involved dental students only ( n = 19), with combinations of student groups ( n = 2) and hygiene students ( n = 1) appearing infrequently. The majority of learning spaces under investigation were clinical facilities within universities or dental schools. Most studies used learning environment surveys, albeit with a limited focus on learning spaces ( n = 14). Mixed ( n = 4), and qualitative methods ( n = 4), were used less commonly. Student opinion was sought in the majority of studies ( n = 15). Conclusions There appears to be limited evidence available regarding the impact of learning spaces on dental professional students. Further collaborative research with all relevant stakeholders is required to support the optimal design of clinical facilities in dental education. Dental education dental students learning space evidence synthesis scoping review Figures Figure 1 Figure 2 Figure 3 Background Dental education may be regarded as a uniquely challenging learning experience, and has been described as a “complex, demanding and often stressful pedagogical procedure” [ 1 ]. It involves the acquisition of the required knowledge, skills and attributes within four to six year programmes, such that graduates are capable of safe and independent professional practice. Clinical experience is gained through the provision of oral healthcare within clinical facilities, usually in hospital or community settings. Learning in clinical settings is fundamental to health professions’ education [ 2 ], and dentistry is no exception. The challenge of delivering education in clinical environments is to create spaces that can be sustainably shared by both clinical and educational activities [ 3 ]. An effective and supportive learning environment influences the quality and safety of patient care, staff wellbeing, trainee learning and socialisation into the profession [ 2 ]. Sub-optimal learning environments have been associated with adverse patient care and learning outcomes [ 4 – 6 ]. The ‘learning environment’ refers to the “social interactions, organisational culture and structures, and physical and virtual spaces that surround and shape the learners’ experiences, perceptions, and learning” [ 7 ]. In health professions’ education, and indeed in higher education generally, high quality learning environments are increasingly recognised as vital for student success, and for facilitating positive clinical learning experiences [ 8 , 9 ]. Gruppen and colleagues proposed a conceptual framework for learning environments in the health professions [ 7 ]. The framework consists of five overlapping core components that form two dimensions; the psycho-social dimension, which includes personal, social and organisational aspects, and the material dimension, which incorporates the physical and virtual aspects. Learning spaces may be defined as the “physical or virtual spaces in which learning and practice occurs” [ 7 ]. This aspect of the learning environment directs attention to the quantity and quality of spaces available. In the clinical aspects of dental programmes, physical spaces may include open and closed dental surgeries, typically situated within teaching hospitals, health centres and dental practices. On the other hand, virtual spaces may relate to the provision of teledentistry, which has recently come to greater prominence because of the COVID-19 pandemic [ 10 ]. Cooper et al. argue that the physical features of the clinical learning environment have critical effects on trainees and educators in health professions’ education, including acquisition and application of knowledge, skills, and values [ 11 ]. Evaluating learning spaces in dental education is important for several reasons, including the potential impact on student learning and competency development, the ability to provide safe and effective patient care, support for integration of digital workflows, facilitation of inter-professional education and assuring the cost-effectiveness of investment. However, it has been acknowledged that measuring the impact of physical space design on learning outcomes in medical education may be challenging, with both assessment and evaluation measures proving difficult to define and implement [ 12 ]. A recent review of learning spaces in higher education concluded that space cannot be singled out as a determinant of positive student outcomes [ 13 ]. Nonetheless, it was acknowledged that the literature suggests a complex relationship between space, interaction and people, which requires exploration in future research. Historically, researchers have noted that dental students’ role in curriculum design has been less than optimal [ 1 , 14 ]. As key stakeholders, their input is now advocated in curriculum development, with ongoing dialogue between staff, students and patients encouraged as part of an educational alliance [ 15 , 16 ]. However, whilst their contribution may have been overlooked in the past, there is evidence that student opinion is increasingly being sought as dental educators seek to interrogate, evaluate and improve their curricula [ 17 ]. Over the last fifteen years, there appears to have been a growing interest in assessing the clinical learning environment from the perspective of dental students [ 18 – 23 ]. The potential influence of the environment on factors such as motivation, attainment of competencies, identification of learning barriers, academic performance, well-being and preparedness for practice have been investigated [ 24 – 29 ]. A variety of study designs, disciplinary contexts, evaluation instruments, and methodologies have been used. However, the impact of learning spaces specifically does not appear to have been extensively studied in the dental literature. The primary objective of this scoping review is to map the available evidence regarding the impact of learning spaces on undergraduate dental professional students during their clinical training. The secondary objectives are to ascertain how learning spaces in undergraduate dental education are evaluated, to identify potential gaps in knowledge, and to inform future primary research. Methods The conduct and reporting of this scoping review is aligned with Joanna Briggs Institute (JBI) Guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) [ 30 , 31 ]. Protocol Development and Registration The development of an a priori protocol before undertaking a scoping review is recommended [ 30 ]. The protocol for this review was registered on the Open Science Framework. Alignment of the Research Questions and Objectives The Population Concept Context (PCC) framework is recommended when constructing clear and meaningful research questions for scoping reviews [ 30 ]. The elements of the PCC framework for this review are outlined in Table 1 . The primary and secondary research questions were subsequently developed and were aligned with the review objectives. Table 1 Development of the research questions using the PCC framework Population Concept(s) Context (PCC) Framework Population Undergraduate students undertaking dentistry, dental therapy, dental hygiene, dental nursing or clinical dental technology. Concepts Learning spaces, defined as the physical or virtual spaces in which learning and practice occur [ 7 ]. Methods of evaluation, including quantitative and qualitative assessment tools. Impact, considered as any effect on students which can be directly or indirectly linked to the learning space. Context Undergraduate dental professional programmes in university, hospital, community or virtual environments in any country, in which students are engaging with patients. Primary and Secondary Research Questions Primary What is the evidence regarding the impact of learning spaces on dental professional students during clinical training at undergraduate level? Secondary What types of dental learning spaces have been evaluated? What methods have been used to evaluate dental learning spaces? What is the available evidence regarding the impact of learning spaces on dental professional students? The elements of the Population Concept(s) Context (PCC) Framework were used to develop the primary and secondary research questions. Eligibility Criteria The eligibility criteria for the inclusion or exclusion of sources of evidence for this scoping review are outlined in Table 2 . To minimise bias, no date or language limitations were set. Table 2 Inclusion and exclusion criteria INCLUDE EXCLUDE Population • Undergraduate (or pre-doctoral) students undertaking dentistry, dental therapy, dental hygiene, dental nursing or clinical dental technology. • Recent graduates providing retrospective information about their undergraduate programme. • Postgraduate students undertaking further specialty training or research programmes. • Qualified dental professionals undertaking Continuing Professional Development (CPD) or additional training. • Faculty staff undertaking further education or training. Concept Learning space : The physical or virtual spaces in which learning and practice occurs, 7 including; • Physical component: “includes brick-and-mortar campus-based teaching and learning buildings, hospitals and clinics, and community sites” [ 7 ]. • Virtual component: “electronic learning environments, curriculum management tools, and digital assistants that deliver content to learners and provide forums (sic) for interaction and learning” [ 7 ]. Literature which pertains to the broader concept of a ‘learning environment’ without sufficient reference to physical or virtual spaces. Such research may be more concerned with the personal, social or organisational components of the learning environment, for example: • Teaching or assessment practice or methods • Curricular development • Didactic content • Pedagogical issues • Student, staff or patient demographics • Regulatory standards • Social or healthcare policy • Clinical guidelines Methods of evaluation which relate to the physical or virtual aspects of learning spaces, including but not limited to: • Specific instruments which include explicit questions on learning spaces, or which allude to the material component of learning environment e.g., Dental Clinical Learning Environment Instrument (DECLEI), Health Education Learning Environment Survey (HELES), Dental Hygiene Student Learning Climate Survey (DHS-LCS), Ambulatory Care Learning Education Environment Measure (ACLEEM) and the Learning Space Rating System (LSRS). • Other quantitative assessment tools e.g., questionnaires. • Qualitative assessment using interviews or focus groups. • Pre-post studies • Feedback from students Methods of evaluation which do not relate to the physical or virtual aspects of learning spaces: • The Dundee Ready Education Environment Measure (DREEM) and the Dental Student Learning Environment Survey (DSLES). • Evaluation by teaching staff of their own performance, including teaching and assessment methods. Impact will be considered as an effect on students which can be directly or indirectly linked to the learning space. Effects may include, but are not limited to: • Acquisition of, or change in, knowledge, skills, attributes or confidence. • Attainment of competences, defined as “professional behaviours and skills required by a graduating dentist in order to respond to the full range of circumstances encountered in general professional practice” [ 76 ], or learning outcomes, defined as “a series of individual and objective outcomes, with shared ownership between students and staff, designed to facilitate the learning and assessment process” [ 15 ]. • Change in learner perceptions (or teacher perception of student-centred outcomes). Any effect on students perceived to result from changes to personal, social or organisational components of the learning environment i.e., not related to physical or virtual learning spaces. Context • Undergraduate dental professional programme delivered within university, hospital or community settings. • Participating in clinical training, placement, rotation, or any interaction with patients. • Any country • Dental specialty training programmes • Vocational training • Graduate internships • Mentoring programmes • Pre-clinical aspects of dental programmes, for example, biomedical science teaching or practical courses in teaching laboratories. Evidence Sources • Peer-reviewed primary research. • Peer-reviewed evidence synthesis studies (systematic, scoping reviews). • Grey literature (dissertations, conference papers or proceedings, websites, institutional or government documents or reports, accrediting organisations’ regulatory standards) • Expert opinion sources (literature reviews, discussion papers). • Book and film reviews • Newspaper articles Publication Dates No limitations will be set. Not applicable Language No limitations will be set. English translation not available. The inclusion and exclusion criteria for this scoping review were aligned with the Population Concept Context (PCC) Framework. No date or language limitations were set. Search Strategy A comprehensive search strategy was developed under the guidance of a research librarian, and deployed in the following databases; MEDLINE, Education Full Text, ERIC, Academic Search Complete, Embase, Wiley Online Library, Web of Science Core Collection and Scopus. Subject headings were used for general concepts, combined with keyword searches within titles and abstracts. Additional File 1 contains an example of a draft search strategy for the Embase database. The database searches were undertaken from inception to 19 December 2024, apart from Education Full Text which was not accessible to the reviewers after 2023. The reference lists of full text sources selected for inclusion were screened for additional records. Key authors were contacted to request potentially relevant sources. Key journals, including the European Journal of Dental Education, the Journal of Dental Education and the Journal of Learning Spaces, were hand searched. Sources of grey literature were identified by searching the ProQuest Dissertations & Theses A&I database, the GreyGuide Repository, the DANS Archive and Google Scholar. The websites of the Association for Dental Education in Europe (ADEE), the American Dental Education Association (ADEA) and EDUCAUSE (a non-profit association committed to advancing higher education) were reviewed for relevant content. The conference proceedings of the annual scientific meetings from 2012 to 2024 of both ADEE and ADEA were hand searched. Evidence Selection The citation details of the records contained in the search results were collated in EndNote™ Version X9.3.3 (Clarivate Analytics, PA, USA). The reference set was de-duplicated, prior to exporting to Rayyan ( https://www.rayyan.ai/ ), a web-based software platform for management of collaborative evidence reviews [ 32 ]. The process of evidence selection was based on the eligibility criteria (Table 2 ), aided by a definitions and elaboration document. Screening of the titles and abstracts of the reference set was undertaken by two of the authors, working independently using ‘blind’ mode in Rayyan, with periodic meetings to resolve any conflicting decisions. Full-text examination of potentially relevant sources was undertaken independently by both reviewers, and any conflicts were resolved by consensus discussion. Data Extraction and Analysis Data extraction was undertaken using a structured charting table, which was aligned with the review objectives, questions and eligibility criteria. One reviewer extracted data for each included source, which was verified by the second reviewer. Basic frequency statistics were used to summarise the data, and the concepts under evaluation were categorised. Results Search Results The selection process is illustrated using an adapted PRISMA 2020 flow diagram (Fig. 1 ) [ 31 ]. Following de-duplication, a total of 997 records were identified though database searches, hand searching of key journals, contacting relevant authors, and from the grey literature. After screening and assessment of eligibility, a total of 22 full text sources were identified for inclusion. The reasons for exclusion of potential sources at the full-text review stage are documented in Fig. 1 . Overview of the Evidence A detailed summary of each of the included sources, listed in chronological order, is presented in Table 3 , which responds to the primary and secondary research questions. Research in this field has been conducted globally, with the greatest number of contributions from the United States of America (USA) and the United Kingdom (UK), respectively. Table 3 Summary of included sources Author Year Title Source Type Description of Participants ▫ Sample size ▫ Dental programme ▫ Year of study ▫ Age ▫ Gender Concept under Evaluation ▫ Type of learning space(s) ▫ Aspect(s) of learning space being investigated Context ▫ Country ▫ Setting Methods Key Findings Related to: ▫ Learning spaces ▫ Evidence of impact on students Craddock [ 36 ] 2008 Outreach Teaching – the Leeds Experience: Reflections after One Year Peer-reviewed journal 48 of 55 final year dental students. Age and gender not reported. Purpose-built outreach dental clinic. Two question items related to students’ opinions of the clinical facilities and the materials provided. Outreach facility in Bradford, UK, linked to Leeds Dental Institute. Narrative description of outreach teaching by the author. Student feedback questionnaire administered at the end of the outreach placement. Student feedback indicated that they appreciated the facilities and materials provided. Saito et al. [ 33 ] 2010 Learning Climate in Dental Hygiene Education: A Longitudinal Case Study of a Japanese and Canadian Programme Peer-reviewed journal 402 2nd and 3rd year dental hygiene students participated over a four-year period. Age and gender not reported. The specific learning spaces in these programmes are not described. Item 1 of the questionnaire related to physical environment, described as ‘the quality of space and privacy afforded to people, the accessibility of necessary supplies and the equipment and supplies available for client care or simulations.’ Two dental hygiene programmes in a Japanese hygiene college and a Canadian community college. Development and use of a survey instrument with ten dimensions relating to learning climate - the Dental Hygiene Student Learning Climate Survey. Canadian students tended to rate the physical environment more favourably. Improvement of physical working space conditions was put forward by the students as a recommendation within the study. Improved scores were obtained for Item 1 over the study period. Anderson et al. [ 18 ] 2011 Undergraduate Dental Education in New Zealand: 2007–2009 Final Year Student Feedback on Clinical Learning Environments Peer-reviewed journal Final year dental students: n = 33 of 68 in 2007; n = 71 of 71 in 2008; n = 52 of 68 in 2009. Age and gender not reported. Limited information regarding the learning spaces was provided, however the authors indicate that clinical training occurs almost entirely within the Dental School. Students were asked to reflect on their learning experiences within clinical learning environments. Faculty of Dentistry, University of Otago, Dunedin, New Zealand A clinical learning environment survey with quantitative and qualitative components, specific to the Faculty of Dentistry. Students' feedback tended to focus on affective aspects of the learning environment rather than physical characteristics. The key role of teaching staff in ‘shaping these environments’ was highlighted. Suggestions for improving physical aspects included updating facilities, providing more space and chairs, and providing access to more materials. Schönwetter et al. [ 24 ] 2011 Assessing Graduating Dental Students’ Competencies: The Impact of Classroom, Clinic and Externships Learning Experiences Peer-reviewed journal 97 graduating dental students, recruited over five consecutive years, from 2005–2009. 39 female; 57 male; one participant chose not to indicate gender. Mean age: 27.7 years The three learning environments included the classroom, clinic and community service experience (or externship). No further details are provided regarding each of these learning spaces. Faculty of Dentistry, University of Manitoba, Canada The Graduating Dental Students Competency Assessment Questionnaire was administered. Questionnaire evaluated self-reported confidence and perceived importance of 50 competencies, and students’ perception of the contribution of three learning environments in competency preparation. The university clinical setting was the environment which students believed had the greatest influence on the attainment of competencies. This was followed by classroom and community service settings. Kossioni et al. [ 19 ] 2014 The Development and Validation of a Questionnaire to Measure the Clinical Learning Environment for Undergraduate Dental Students (DECLEI) Peer-reviewed journal 202 dental students: 153 4th and 5th year dental students; 49 of 51 students attending a European conference. 119 female; 69 male; 14 did not report their gender. Mean age: 22.4 years Limited information regarding learning spaces was provided except to indicate that the majority of participants attended Athens Dental School. Athens Dental School, Greece Students from the UK, Sweden, Romania, Slovakia, Portugal, Slovenia, Turkey, France, Ireland and Serbia also participated. Content development and validation of a new questionnaire, the Dental Clinical Learning Environment Instrument (DECLEI). The final instrument included 24 items divided into three domains. Resulted in 24-item survey in three domains. Three questions related to physical spaces were retained; clinical infrastructure, use of up-to-date materials and equipment and speed of addressing technical problems with units. Radford and Hellyer [ 37 ] 2016 Belongingness in Undergraduate Dental Education Peer-reviewed journal 76 of 80 final year dental students Age and gender not reported. Dental students’ experience of a residential outreach placement, specifically focusing on the concept of belongingness, and how this related to their development as practitioners. The University of Portsmouth Dental Academy, UK – an ‘outreach dental clinic’. Dental students from Kings College London Dental Institute participated in a residential placement, which is integrated with dental nursing, hygiene and therapy students from the local university. Questionnaire with two quantitative and two qualitative questions, with the latter generating free text responses for subsequent thematic content analysis. In the qualitative data, the physical environment was identified as a sub-theme of the clinical environment theme. Participants highlighted the facilities, equipment, and the clinical bays in their responses to questions regarding belongingness. Halawany et al. [ 39 ] 2017 Application of the European-Modified Dental Clinical Learning Environment Inventory (DECLEI) in Dental Schools in Riyadh, Saudi Arabia Peer-reviewed journal 613 of 1178 4th and 5th year dental students 302 female; 311 male; Male and female students were segregated in each of the institutions. Mean age: 23.7 years Limited information provided on specific clinical learning spaces, but all students experienced both school-based clinics and community-based services. Two public and two private dental schools in Riyadh, Saudi Arabia. The DECLEI questionnaire used, which was piloted and validated for the student population in this study. The resulting modifications to the questionnaire related to sequencing of questions. Significant differences noted between student responses at public and private schools for each of the three questions related to learning spaces, with private schools receiving higher ratings. Krois et al. [ 42 ] 2018 Preliminary Validation of an Instrument to assess Students’ Perceptions of Clinical Learning Environments at U.S. Dental Schools Peer-reviewed journal 144 3rd and 4th year dental students. Age and gender not reported. Limited information regarding the specifics of the learning spaces experienced by these students at this survey validation stage. University of Iowa College of Dentistry, USA Preliminary validation of 24-item DECLEI questionnaire in a single dental school in the United States. Relevance and content validity were assessed. Principal Component Analysis was used as part of the process. 18 of the initial 24 items were grouped into five domains, one of which was ‘Equipment and Patient Issues’. The DECLEI questions on materials, equipment and technical support for units were retained, whilst the question on clinical infrastructure was removed. Sethi and Khan [ 38 ] 2018 Is the Dental Clinical Learning Environment Suitable? A Survey of Khyber Pakhtunkhwa, Pakistan Peer-reviewed journal 553 respondents, including 298 undergraduate dental students in clinical years (3rd and final year); the remainder were postgraduate dentists. 345 female; 208 male. Mean age not reported, majority under 25 years. Limited information on the specific learning environment however the authors indicate that the public college was centrally located to facilitate access for patients. One public and two private dental colleges in one province in Pakistan. 24-item DECLEI questionnaire was administered. The questionnaire was first validated by three ‘experts’ and then piloted (n = 10). Some terms were changed to adhere to local contexts. A section for free-text comments was added to the questionnaire. The responses indicated that students in private colleges rated their clinical infrastructure, materials and equipment, and technical support for the dental units more highly than their peers in the public college. Based on these results, the authors recommended improving the infrastructure of the public colleges. The et al. [ 35 ] 2018 Dental Students’ and Staff Perceptions of the Impact of Learning Environment Disruption on their Learning and Teaching Experiences Peer-reviewed journal 296 students responded to the survey; 13 students participated in focus groups; 4 students participated in individual interviews. Dental, dental therapy and dental technician students were represented. Age and gender not reported. The clinical facilities in which patient care was delivered, the school library and non-clinical teaching spaces were included. This iteration of the annual survey specifically explored the impact of disruptions to the physical learning environment on students’ learning and staff teaching experiences, e.g., limited space availability, noise and hazardous demolition work. Faculty of Dentistry, University of Otago, Dunedin, New Zealand, during a period of major building redevelopment. An annual, online, feedback survey was tailored to include the question, ‘Do you have any comments regarding your teaching and learning facilities?’. and learning facilities?’ Data was also collected via interviews and focus groups. Students placed greater value on staff contributions than the physical learning environment. Despite temporary physical constraints, a positive academic environment was created by the people in the Dental School. The results of the focus groups and interviews indicated that the physical environment, people and relationships were intertwined. Krois et al. [ 43 ] 2020 Steps Towards Validation of the Dental Education Clinical Learning Instrument (DECLEI) in American Dental Schools (DECLEI-USA) Peer-reviewed journal 286 dental students in 3rd and 4th year Gender partially reported as: 156 female; 125 male. Age not reported. Limited information regarding the specifics of the learning spaces experienced by these students as part of this validation exercise. University of Iowa College of Dentistry and University of Texas Health Science Centre, USA Further validation of 24-item DECLEI questionnaire in a two dental schools. Two approaches were used for validation, Regression Model and Item-Total Correlation. Developed 9-item Mini DECLEI-USA, in which the questions on clinical infrastructure, and use of up-to-date materials and equipment were retained. The authors also proposed a 20-item DECLEI-USA, in which the question on speed of addressing technical problems with units was retained. Lau et al. [ 49 ] 2020 Dental Students’ Perceptions of Learning Space: A Focus Group Study Peer-reviewed journal 16 recent dental graduates. 12 female; 4 male. Mean age: 24 years Participants’ feedback was sought on orthodontic learning spaces for lectures, tutorials, clinics, self-study and networking. The students were asked about the ‘space and infrastructure’ provided for these activities. The clinical learning spaces were identified as clinics used for multidisciplinary treatment planning. There was limited information regarding the physical parameters of the clinic. Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia Two focus group discussions were undertaken with eight students in each group. The participants were allocated to the groups based on grades; Group 1 participants had higher grades and Group 2 had lower grades. The findings indicate that the students’ learning experiences are impacted by a perception of ‘crowding’. Some students felt that the interactions between clinician and patients were affected by the presence of too many students. Suggestions for improvement included adjusting the ratio of students to patients, or setting up an interactive, moderated, live-streaming session in a separate location. Ali et al. [ 34 ] 2021 The Perception of Undergraduate Dental Students Toward a Clinical Learning Environment at School of Dentistry and Oral Health, Fiji National University, Fiji Peer-reviewed journal 130 of 157 undergraduate students with clinical experience: Dental Hygiene (n = 5) Bachelor of Oral Health (n = 58) Dentistry (n = 67) 94 female; 36 male. Age range: 19–43 years, with majority aged from 20–29 years. Limited information regarding the specifics of the clinical spaces, however the authors indicate that the University dental clinics are new, with contemporary materials and equipment. School of Dentistry and Oral Health, University of Fiji The 24-item DECLEI questionnaire was administered. In relation to the relevant DECLEI questions for this review; ‘Clinical infrastructure’ was rated as excellent; ‘Using up-to-date materials and equipment’ and ‘technical problems being dealt with quickly’, were rated as good. Krois et al. [ 44 ] 2021 Preliminary Validation of the Dental Clinical Learning Environment Instrument in a Brazilian Dental School Peer-reviewed journal 155 of 169 dental students in 7th and 8th semester of a 10-semester programme, all of whom had at least 1 year of clinical experience. 106 female; 49 male. Mean age: 23.9 years Limited information regarding the specifics of the learning spaces experienced by these students as part of this validation exercise. The Dental School at the Federal University of Pelotas, Brazil Preliminary validation of the 24-item DECLEI questionnaire in a single dental school in Brazil. Relevance and content validity were assessed. Principal Component Analysis was used as part of the validation process. A 17-item DECLEI questionnaire was proposed, in which the questions related to clinical infrastructure, materials and equipment, and technical support for the dental units were retained. The authors highlighted the challenges of validating learning environment instruments in different cultures. Nath et al. [ 40 ] 2022 The Outcome of a New Teledentistry Initiative in Response to the COVID-19 Pandemic: A Cross-sectional Study Peer-reviewed journal 200 of 266 3rd and 4th year dental students. 96 female; 101 male; Gender not disclosed by 3 participants. Age not reported. Teledentistry sessions, termed ‘eVisits’, were held in a conference room, with a group of eight to nine students, supervised by a faculty member. Clinical engagement with patients took place using the Google Voice app supported by software to record the interaction. An educational teledentistry initiative at the Loma Linda University School of Dentistry, California, USA. The study was carried out against the backdrop of the COVID-19 pandemic. A 9-item survey, with three sections as follows: Two demographic questions; Six questions on perceived teaching effectiveness; One open-ended question. The majority believed that the university was providing a good educational environment by initiating teledentistry sessions and that their communication skills had improved. Over half of the students felt that their ability to perform oral evaluation had improved because of participation. The free-text responses included a suggestion to incorporate a video component, and acknowledgement of background noise as a barrier to communication. Pellicer et al. [ 47 ] 2022 Transformation of a University Educational Space through Musical Flow on Undergraduate Dental School Students during the COVID-19 Pandemic: A Pilot Study Peer-reviewed journal 119 of 135 5th year dental students. 69 female; 50 male Age range: majority aged from 21–25 years. Within a polyclinic environment, ambient music was played from a computer in each ‘office’, at a constant average volume (≤ 60db), whilst students were treating patients. Each student was able to select their own preferred music. There is limited information regarding the physical parameters of the clinic. Department of Clinical Dentistry at the private European University of Madrid, Spain. The study was carried out against the backdrop of the COVID-19 pandemic. Experimental study with intervention (n = 63) and control (n = 56) groups. The intervention group listened to music, whilst the control group did not. Data was gathered via a questionnaire and a visual analogue scale, which was used to measure level of anxiety before and after treating a patient. All students were less anxious after treatment, with those who listened to music experiencing a greater reduction in anxiety. 86% of the intervention group considered music to be a useful tool to reduce anxiety. 89% of this group also believed that listening to music improved their clinical work. Ross and Holder [ 22 ] 2022 Dental Undergraduate Students' Perceptions about Placements in Primary Dental Care during the Undergraduate Dental Curriculum: A Qualitative Evidence Synthesis Peer-reviewed journal The majority of included studies reported on data from undergraduate dental students in 4th and 5th year. Two further studies related to students post-qualification. Participant numbers ranged from five to 320, with some studies taking place longitudinally, encompassing data from up to five academic years. Limited demographic data available. Students participated in a primary dental care placement away from the teaching hospital setting. The format varied from school to school, and included both general dental practice and purpose-built outreach centres. The review aimed to explore the perceptions of undergraduate dental students in the UK on their placements in primary care. Undergraduate programmes from seven different UK dental schools. A Qualitative Evidence Synthesis approach was utilised, which incorporated a database search in addition to contacting all UK dental schools for details of evaluations of primary care placements. The Critical Skills Appraisal Programme qualitative study framework was used to appraise studies and a narrative synthesis approach was used to describe the data. 11 studies were selected for inclusion, with date of publication ranging from 2004 to 2019. The physical attributes of the learning environment had varying effects. Positive impacts : Preparation of the surgery allowed students to relax and enhanced their learning experience; Access to a kitchen made the students feel part of a team; Placement was a ‘true representation’ of the practice environment, helping graduates to settle into their post after graduation. Negative impact : Problems with missing or faulty equipment had a detrimental effect. Shehada et al. [ 46 ] 2023 Major Stress Sources Amongst Dental Students at Damascus University, Syria Peer-reviewed journal 365 of 2534 dental students in 3rd (n = 95), 4th (n = 133) and 5th (n = 138) year. 212 female; 153 male. Age range: 20–24 years Limited information regarding the clinical learning spaces is provided, however the authors indicated that the university was greatly lacking in teaching staff, dental materials and equipment. ‘Lack of dental equipment’ was considered a source of stress for students. Faculty of Dentistry, Damascus University, Syria. The authors reference the so-called ‘Arab Spring’ which took place in the early 2010s and has led to ongoing disruption in Syria. A modified 29-item version of the Dental Environment Stress (DES) questionnaire was administered following translation into Arabic, validation and pre-testing. A question item related to dental equipment was added following recommendation from pre-testing. The lack of dental equipment was identified as the single factor which caused the most stress. The authors suggest that students may not be adequately prepared to enter the workforce if they have not trained with high quality, modern dental equipment during the clinical phase of their education. Javed et al. [ 45 ] 2023 Undergraduate Students’ and Interns’ Perception towards Learning Environment at Dental Clinics, Qassim University, Saudi Arabia Peer-reviewed journal 87 of 111 4th and 5th year dental students and interns, with 5th years accounting for the majority of responses (42.5%). 49 female; 38 male. Age not reported. Limited information available regarding the specifics of the clinical spaces. College of Dentistry, Qassim University, Saudi Arabia. The 24-item DECLEI questionnaire was administered. In relation to the relevant DECLEI questions for this review, ‘clinical infrastructure’, ‘use of up-to-date materials and equipment’, and ‘technical problems being dealt with quickly’, were rated as good. Akinpelu et al. [ 48 ] 2024 Clinical Students’ Perception of Educational Environment in a Nigerian University: A Mixed Method Study Peer-reviewed journal 223 final year students in clinical programmes; nursing, medicine, physiotherapy and dentistry (n = 28). 13 female; 15 male. Mean age: 25 years Limited information available regarding the clinical learning spaces in the dental programme. The College of Medicine at The University of Ibadan, Oyo, Nigeria. Mixed methods study in which students completed the Dundee Ready Education Environment Measure questionnaire, followed by a qualitative component. Four focus groups representing each of the clinical programmes were conducted with six students in each. The findings in relation to learning spaces for dental education formed a relatively small component of the overall study. One of the themes identified in the qualitative data related to infrastructure and facilities. Students felt that they did not have ready access to appropriate equipment and facilities. McCormick et al. [ 41 ] 2024 Evaluation of a Student Telehealth Rotation at the Columbia University College of Dental Medicine Peer-reviewed journal 89 of 95 3rd year dental students. No demographic data provided. Evaluation of a week-long telehealth rotation involving virtual interaction with patients on Zoom meetings. A group of two to three students each joined from their own computer and were supervised by a faculty member. The virtual visits include history and visual assessment with the patient using the camera on their device. A telehealth rotation at Columbia University College of Dental Medicine, New York, USA. The rotation was introduced following the onset of the COVID-19 pandemic. Completion of a post-rotation evaluation on a digital learning platform. Students were asked to respond qualitatively to five open-ended questions, of which three related to evaluation of the telehealth rotation. Students reported improvements in clinically relevant skills and knowledge, which the authors suggest implies that telehealth rotations can supplement traditional clinical dental education and reinforce concepts essential to patient care. Students reported that the main challenge was technology issues, in particular patient access, or visual limitations during the exam. Oderinu et al. [ 50 ] 2024 Exploring Dental Students’ Perceptions of their Clinical Learning Environment: A Qualitative Study to Evaluate the Curriculum Peer-reviewed journal 16 5th and 6th year dental students. 9 female; 7 male. Age range: 21–30 years An evaluation of student experiences within the clinical learning environment of various specialty-based dental departments in a tertiary hospital setting. The student experience of learning within the dental clinics, along with suggestions for improvements, were the subject of the investigation. Faculty of Dental Sciences of the College of Medicine, University of Lagos, Nigeria A qualitative approach was undertaken, with four focus group discussions involving four students in each group. The focus group schedule consisted of four open questions, followed by specific questions to explore positive and negative aspects of student experience. A recent upgrade to the equipment and facilities was identified as an enabler of learning in the dental clinics. On the other hand, non-availability of required dental materials and inadequate environmental cooling of clinical spaces were identified as barriers to learning. Data was extracted from each included source using structured headings as shown in this table. The headings were designed to align with the primary and secondary research questions. Key aspects of the included sources, including year of publication, relevant student population, type of learning space and study design, are summarised in Fig. 2 . The number of publications per year appears to be trending upwards (Fig. 2 A). The majority of studies involved dental students, with one study including dental hygiene students only [ 33 ], and two studies including combinations of students from different programmes (Fig. 2 B) [ 34 , 35 ]. Types of Dental Learning Spaces The majority of learning spaces under investigation were clinical facilities located within individual universities or dental schools (Fig. 2 C). All three of the studies from the UK were concerned with evaluation of student experiences of dedicated outreach facilities or placements with primary dental care settings [ 22 , 36 , 37 ]. A multi-site study related to two dental hygiene programmes in Canada and Japan explored students’ opinions of a variety of college-based and off-site settings [ 33 ]. Classroom, clinics and community service settings were compared in a Canadian study assessing students’ self-reported confidence to carry out defined competencies [ 24 ]. Two studies, based in Pakistan and Saudi Arabia, compared dental students’ perception of the clinical learning environment in public and private colleges [ 38 , 39 ]. Two studies were concerned with the virtual environment, in which students’ perceptions of ‘teledentistry’ initiatives were explored [ 40 , 41 ]. Methods of Evaluation of Dental Learning Spaces All of the included publications related to primary research, with the exception of one qualitative evidence synthesis [ 22 ]. Most studies used quantitative approaches to evaluation, with mixed and qualitative methods appearing less frequently (Fig. 2 D). Four of the quantitative studies related to development and validation of the Dental Clinical Learning Environment Instrument (DECLEI) [ 19 , 42 – 44 ], which was used in four further publications [ 34 , 38 , 39 , 45 ]. The Dental Hygiene Student Learning Climate Survey (DHS-LCS) was used in one of the included publications [ 33 ]. One study used the Dental Environment Stress (DES) questionnaire, which was modified by addition of a question related to dental equipment [ 46 ]. Pellicer et al. utilised a pre-post interventional design, assessed via questionnaire and visual analogue scale to measure anxiety [ 47 ]. A locally developed survey was used for the remaining three quantitative studies [ 24 , 36 , 40 ]. The mixed methods designs encompassed questionnaires with quantitative and qualitative elements [ 18 , 37 ], and questionnaires combined with interviews and/or focus groups [ 35 , 48 ]. Four qualitative studies were included [ 22 , 41 , 49 , 50 ]. The majority of studies were conducted at single time points, with three studies taking place longitudinally [ 18 , 24 , 33 ]. Evidence Related to Impact Most of the included studies sought student opinion or perception of their learning environment in a particular setting (Fig. 3 ) [ 18 , 19 , 33 , 34 , 36 , 38 – 45 , 48 , 49 ]. Three studies documented the influence of the learning space on student experience within their dental programmes. The et al. noted that the disruption caused by construction was mitigated by a positive academic environment [ 35 ]. Ross and Holder documented attributes of the learning space which had both positive and negative effects on students during primary dental care placements [ 22 ]. Similarly, aspects of the learning space were found to act as both an enabler and a barrier to learning in a Nigerian dental school [ 50 ]. In a further study which explored the relationship between educational setting and preparedness to carry out defined competencies, participants indicated that the setting which was most effective was the university clinic, followed by the classroom, and then community-based clinics, although there was limited information regarding the physical parameters of each context [ 24 ]. Finally, three studies associated learning spaces with an emotional state. The facilities, equipment and clinical bays in a purpose-built primary care facility were highlighted by students in relation to a sense of ‘belongingness’ during a residential outreach placement [ 37 ]. The findings of an experimental study which investigated the effect of ambient music played during clinical sessions indicated that music may help students to feel less anxious while they are treating patients [ 47 ]. Poor access to dental equipment was a major source of stress for dental students in a Syrian university [ 46 ]. Discussion This scoping review provides an overview of the available evidence regarding the impact of learning spaces on dental professional students during clinical aspects of their education. The findings indicate that limited research has been conducted on this topic to date. Most of the included studies were conducted in a single centre at one time point. The majority of clinical learning spaces were located in university-based dental hospitals or schools. Since a significant proportion of undergraduate experience is often provided in a central school or hospital, this finding was reflective of the pedagogical approach adopted in many dental curricula. In more recent times, an alternative model has emerged, with training provided in community-based settings [ 51 – 54 ]. The development of dental outreach teaching centres to facilitate preparation for independent practice was highlighted in a recent scoping review [ 55 ]. The layout, size and equipment available in a purpose-built, dental outreach centre were well-described by one of the included articles [ 36 ]. In general, however, information regarding the physical aspects of the clinical learning environments was lacking, which inhibits comparison between settings. In clinical education research, questionnaires are useful tools for gathering information about abstract ideas or concepts that are otherwise difficult to quantify, such as opinions, attitudes, beliefs or behaviours which are not directly observable [ 56 ]. On the other hand, these types of studies tend to be limited by the range of questions possible, and the level of detail that can be collected at a single time point [ 57 ]. There is merit to the longitudinal approach adopted in two of the included studies, which allowed identification of issues and implementation of improvements [ 18 , 33 ]. In other studies, questionnaires were used to explore student opinion on a wide variety of diverse issues, from the quality of clinical infrastructure and equipment, to the influence of ambient music or construction on learner experience [ 33 – 35 , 38 , 39 , 47 ]. A recent scoping review identified a wide array of questionnaires used to assess student perception of the learning environment in health professions’ education [ 58 ]. This can also be seen in dental education with multiple instruments available, however, attention to the physical aspects of learning spaces is limited. The Dundee Ready Education Environment Measure (DREEM), originally developed for medical education, is in widespread use in dental contexts [ 23 , 59 – 61 ]. However, this tool does not address learning spaces. Similarly, the Dental Student Learning Environment Survey (DSLES) does not reference learning spaces explicitly [ 14 ]. On the other hand, the Dental Clinical Learning Environment Instrument (DECLEI) includes questions on materials, equipment, clinical infrastructure and dental units [ 19 , 42 – 45 ]. Likewise, Item 1 of the Dental Hygiene Student Learning Climate Survey encompasses the ‘quality of space and privacy’, and the ‘accessibility of necessary supplies and equipment’ [ 33 ]. The recently developed Health Education Learning Environment Survey (HELES) also includes statements on technology and quality of the physical environment [ 62 ]. Recently, the Learning Space Rating System (LSRS), developed by EDUCAUSE, has been used in a university medical setting [ 63 , 64 ]. The LSRS is designed to assess the potential of formal and informal spaces to support student learning. On the other hand, qualitative research has the potential to enhance our understanding of aspects of teaching and learning by going beyond ‘surface description’ [ 65 ]. Mixed-method and qualitative approaches, including focus groups, interviews and qualitative evidence synthesis, featured in this review [ 22 , 48 – 50 ]. Qualitative analysis of student feedback or free-text responses to open-ended questions was also evident [ 18 , 35 , 37 , 41 ]. Within dental education, qualitative methods can be used to explore specific elements of pedagogy and aspects of teaching, learning and assessment, providing an in-depth, contextualised understanding of student experience [ 66 ]. When evaluating learning environments for inter-professional care, Kvan argues that qualitative data about the learning experience must be collected to provide evidence for the influence of design on learning outcomes [ 67 ]. Impact may be defined as that which occurs as a result of the outcomes of an intervention [ 68 ]. Impacts are best identified through a broad range of evidence which provides robust verification for enhanced knowledge, behaviours and practices, and it should include a mix of qualitative and quantitative data [ 68 ]. A recent systematic review and meta-analysis used improvements in knowledge, skills and clinical behaviours for health professionals and students as an outcome measure to assess the efficacy of adaptive e-learning environments [ 69 ]. However, it is acknowledged that identifying the impact of a specific intervention or pedagogical development may be challenging, given the multi-faceted nature of dental education. In this scoping review, self-reported improvement in clinical skills in association with the learning space was alluded to in three studies [ 24 , 40 , 41 , 47 ]. However, the reliability of these findings is low, since there was no independent verification of the students’ clinical performance. Furthermore, the information provided about the learning spaces is generally limited, and thus, it is difficult to draw conclusions about the specific impacts of the space in the context of the wider academic environment. In general, evidence of impact of the learning space on dental professional students was limited. Interestingly, more explicit links to the physical attributes of learning spaces can be seen in an exploration of dental students’ sense of belongingness, with evidence suggesting that the space, facilities and equipment influenced the students’ journey towards independent practice [ 37 ]. In a review of primary dental care placements, Ross and Holder also highlighted the learning environment as a key factor in increasing student confidence [ 22 ]. Students provided examples from the physical environment, such as the surgery being set up in advance, which helped them to feel relaxed and enhanced their learning [ 70 ]. However, another study included in this review cited negative aspects of the physical environment, such as missing or faulty equipment, which had a detrimental effect on student experience [ 71 ]. Implications for Future Research In the studies included in this review, the role of the student was usually limited to provision of feedback or opinion regarding an aspect of dental education. It is certainly important to consider student views in this manner, and there is consensus in the dental literature that student feedback should be used to inform curricular development [ 1 , 14 , 17 ]. However, there appears to be limited evidence that students are being involved as partners in learning space design. The notion of the ‘student voice’ in relation to dental education is well articulated by Subramanian et al. [ 17 ]. They argue for greater emphasis on the voice of the student in pedagogical research, by allowing students the opportunity to dynamically influence their learning process and environment [ 72 ]. This ethos underpins the work of Ebbeling and colleagues, which examined dental student perceptions of their clinical learning environment in order to enhance learning outcomes [ 20 ]. Going forwards, an evidence-based approach to learning space design from the perspective of students and teachers would be of benefit to all stakeholders. Globally, dental curricula are undergoing reform, due in part to the need to incorporate technological advances, including the digital dentistry workflow [ 73 ], the drive for improved sustainability [ 74 ], and re-orientation of services towards delivery of universal oral healthcare [ 75 ]. As institutions consider investing in the re-design and re-orientation of new or existing clinical facilities, it is essential that research is embedded within the curriculum to facilitate ongoing investigation of the influence of physical and virtual spaces. Ross and Holder suggest that dental schools should be evaluating their training, doing so in a cohesive way, sharing results, and should consider a longitudinal approach [ 22 ]. Limitations Within the conceptual framework proposed by Gruppen, learning spaces are encompassed within the broader construct of the learning environment [ 7 ]. It is acknowledged that the influence of physical and virtual environments are interconnected with Gruppen’s psycho-social dimension. As such, the findings of this review regarding learning spaces are not intended to be considered in isolation of the broader educational environment. A potential limitation of the search strategy relates to the variability in terminology regarding learning spaces and environments. Disciplinary differences may exist with respect to the interpretation of terms such as, ‘learning space’, ‘learning environment’, ‘learning climate’, etc. The review team maintained flexibility in their approach to identification of potential synonyms throughout the source selection process. It was also necessary to place some limits on components of the search strategy e.g., choice of key journals and websites. Consideration was given to the potential relevance, available resources, and applicability to the design of future primary research. Finally, a critical appraisal of the quality of the included studies was not carried out due to the exploratory nature of the scoping review as an evidence synthesis method. Conclusions Given the unique nature of dental clinical learning spaces, in which patient safety must be balanced with students’ educational needs, in addition to the high cost of dental education, and accreditation requirements, it is important to take stock of the physical estate of dental schools. The current evidence base​ regarding the impact of learning spaces on dental professional students during clinical training at undergraduate level is limited. Most of the research to date relates to teaching hospital or university settings. Quantitative methods using dental learning environment survey tools are commonly used, albeit with a limited focus on learning spaces. Further research, conducted in partnership with students, is required to support optimal design of clinical facilities in dental education programmes. Abbreviations JBI Joanna Briggs Institute JBI PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews PCC Population Concept Context DECLEI Dental Clinical Learning Environment Instrument HELES Health Education Learning Environment Survey DHS-LCS Dental Hygiene Student Learning Climate Survey ACLEEM Ambulatory Care Learning Education Environment Measure LSRS Learning Space Rating System DREEM Dundee Ready Education Environment Measure DSLES Dental Student Learning Environment Survey ADEE Association for Dental Education in Europe ADEA American Dental Education Association DES Dental Environment Stress Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Data is provided within the manuscript and a supplementary information file. Competing interests The authors declare that they have no competing interests. Funding No funds were received for this research project. Author’s contributions SL and BS conceived the idea for this review. SL designed and registered the study protocol. FB critically reviewed the protocol before registration. SL carried out the data searches. SL and KP performed initial and final screening of articles. BS aided in resolution of conflicts during the screening process. All authors were involved in data analysis and review of results. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank Ms Virginia Conrick, Academic Success Librarian, University College Cork, for her support in designing the search strategy for this review. 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Lucey","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDACZgY2ZhDNB+ZVgAjGBuK0sIF5Z4jRwoCshbGNCHfJtzMfe1xQc4eBTSL54WPeeYfl+RuYGx/g02JwmC3deMaxZ0AtacbGvNsOG844wNhsgFcLM4+ZNA/bYaCWHDZpoJYEA6DzJPA6rBmk5R9YC/tv3jlgLe0/8HrmMFALbxvEFmbeBogteHWA/cLbd5iHjeeZseScY+mGMw4zNuN3WP/hY495vh2W42dPfvjhTY21PH97+8MPeK2BAh4QwQQmmYlRDwOM+L09CkbBKBgFIxUAAIjMPLRGp8XtAAAAAElFTkSuQmCC","orcid":"","institution":"Cork University Dental School and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Siobhán","middleName":"M","lastName":"Lucey","suffix":""},{"id":538440354,"identity":"ccbe4844-4a4b-4374-9c06-7b50b0a81e7d","order_by":1,"name":"Katie Power","email":"","orcid":"","institution":"Munster Technological 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09:35:47","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":210208,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7723267/v1/9f61ac7ca006d9bd7d031cce.html"},{"id":95005728,"identity":"7ce229c4-ab52-44da-875b-c0bc14453d9d","added_by":"auto","created_at":"2025-11-03 09:35:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":122939,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA-ScR Flow Diagram. \u003c/strong\u003eFlow diagram illustrating the number of records identified, screened, assessed for eligibility, and included in the scoping review, as per the PRISMA Extension for Scoping Reviews.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7723267/v1/f354bd403ca450e320f03cdd.png"},{"id":95221062,"identity":"b1887c89-ff8d-40cd-91bc-324411eba3d6","added_by":"auto","created_at":"2025-11-05 16:18:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":134444,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA-D. Summary Charts. A. \u003c/strong\u003eNumber of included records per year of publication; \u003cstrong\u003eB.\u003c/strong\u003e Number of publications per student population; \u003cstrong\u003eC. \u003c/strong\u003eTypes of dental learning spaces which have been evaluated; \u003cstrong\u003eD. \u003c/strong\u003eStudy designs used to evaluate dental learning spaces.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7723267/v1/987e99c3c29145eccb9df6e2.png"},{"id":95005734,"identity":"d9ab1360-4719-4b47-8ed5-f198c70a390b","added_by":"auto","created_at":"2025-11-03 09:35:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":108969,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvidence related to impact of learning spaces on students.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7723267/v1/57bf3bd00b1dfecb1620e854.png"},{"id":95519981,"identity":"9e4c6e18-f7a2-4a28-94e0-1df92a9e72ea","added_by":"auto","created_at":"2025-11-10 09:09:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2557902,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7723267/v1/3c60460e-2c6a-4612-ae73-0fe3564fe1a4.pdf"},{"id":95005729,"identity":"3b7aee57-e4a8-4f03-81f4-e618d78cae35","added_by":"auto","created_at":"2025-11-03 09:35:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14996,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7723267/v1/5d22465d6119fa67e2f8e4a7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Learning Spaces in Undergraduate Dental Education: A Scoping Review","fulltext":[{"header":"Background","content":"\u003cp\u003eDental education may be regarded as a uniquely challenging learning experience, and has been described as a \u0026ldquo;complex, demanding and often stressful pedagogical procedure\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It involves the acquisition of the required knowledge, skills and attributes within four to six year programmes, such that graduates are capable of safe and independent professional practice. Clinical experience is gained through the provision of oral healthcare within clinical facilities, usually in hospital or community settings. Learning in clinical settings is fundamental to health professions\u0026rsquo; education [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and dentistry is no exception. The challenge of delivering education in clinical environments is to create spaces that can be sustainably shared by both clinical and educational activities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. An effective and supportive learning environment influences the quality and safety of patient care, staff wellbeing, trainee learning and socialisation into the profession [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Sub-optimal learning environments have been associated with adverse patient care and learning outcomes [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe \u0026lsquo;learning environment\u0026rsquo; refers to the \u0026ldquo;social interactions, organisational culture and structures, and physical and virtual spaces that surround and shape the learners\u0026rsquo; experiences, perceptions, and learning\u0026rdquo; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In health professions\u0026rsquo; education, and indeed in higher education generally, high quality learning environments are increasingly recognised as vital for student success, and for facilitating positive clinical learning experiences [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Gruppen and colleagues proposed a conceptual framework for learning environments in the health professions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The framework consists of five overlapping core components that form two dimensions; the psycho-social dimension, which includes personal, social and organisational aspects, and the material dimension, which incorporates the physical and virtual aspects.\u003c/p\u003e\u003cp\u003eLearning spaces may be defined as the \u0026ldquo;physical or virtual spaces in which learning and practice occurs\u0026rdquo; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This aspect of the learning environment directs attention to the quantity and quality of spaces available. In the clinical aspects of dental programmes, physical spaces may include open and closed dental surgeries, typically situated within teaching hospitals, health centres and dental practices. On the other hand, virtual spaces may relate to the provision of teledentistry, which has recently come to greater prominence because of the COVID-19 pandemic [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Cooper \u003cem\u003eet al.\u003c/em\u003e argue that the physical features of the clinical learning environment have critical effects on trainees and educators in health professions\u0026rsquo; education, including acquisition and application of knowledge, skills, and values [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEvaluating learning spaces in dental education is important for several reasons, including the potential impact on student learning and competency development, the ability to provide safe and effective patient care, support for integration of digital workflows, facilitation of inter-professional education and assuring the cost-effectiveness of investment. However, it has been acknowledged that measuring the impact of physical space design on learning outcomes in medical education may be challenging, with both assessment and evaluation measures proving difficult to define and implement [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A recent review of learning spaces in higher education concluded that space cannot be singled out as a determinant of positive student outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Nonetheless, it was acknowledged that the literature suggests a complex relationship between space, interaction and people, which requires exploration in future research.\u003c/p\u003e\u003cp\u003eHistorically, researchers have noted that dental students\u0026rsquo; role in curriculum design has been less than optimal [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As key stakeholders, their input is now advocated in curriculum development, with ongoing dialogue between staff, students and patients encouraged as part of an educational alliance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, whilst their contribution may have been overlooked in the past, there is evidence that student opinion is increasingly being sought as dental educators seek to interrogate, evaluate and improve their curricula [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Over the last fifteen years, there appears to have been a growing interest in assessing the clinical learning environment from the perspective of dental students [\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The potential influence of the environment on factors such as motivation, attainment of competencies, identification of learning barriers, academic performance, well-being and preparedness for practice have been investigated [\u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A variety of study designs, disciplinary contexts, evaluation instruments, and methodologies have been used. However, the impact of learning spaces specifically does not appear to have been extensively studied in the dental literature.\u003c/p\u003e\u003cp\u003eThe primary objective of this scoping review is to map the available evidence regarding the impact of learning spaces on undergraduate dental professional students during their clinical training. The secondary objectives are to ascertain how learning spaces in undergraduate dental education are evaluated, to identify potential gaps in knowledge, and to inform future primary research.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe conduct and reporting of this scoping review is aligned with Joanna Briggs Institute (JBI) Guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eProtocol Development and Registration\u003c/h2\u003e\u003cp\u003eThe development of an \u003cem\u003ea priori\u003c/em\u003e protocol before undertaking a scoping review is recommended [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The protocol for this review was registered on the Open Science Framework.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAlignment of the Research Questions and Objectives\u003c/h3\u003e\n\u003cp\u003eThe Population Concept Context (PCC) framework is recommended when constructing clear and meaningful research questions for scoping reviews [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The elements of the PCC framework for this review are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The primary and secondary research questions were subsequently developed and were aligned with the review objectives.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eDevelopment of the research questions using the PCC framework\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePopulation Concept(s) Context (PCC) Framework\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate students undertaking dentistry, dental therapy, dental hygiene, dental nursing or clinical dental technology.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eConcepts\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLearning spaces, defined as the physical or virtual spaces in which learning and practice occur [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMethods of evaluation, including quantitative and qualitative assessment tools.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImpact, considered as any effect on students which can be directly or indirectly linked to the learning space.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContext\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate dental professional programmes in university, hospital, community or virtual environments in any country, in which students are engaging with patients.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary and Secondary Research Questions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat is the evidence regarding the impact of learning spaces on dental professional students during clinical training at undergraduate level?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eSecondary\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat types of dental learning spaces have been evaluated?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat methods have been used to evaluate dental learning spaces?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat is the available evidence regarding the impact of learning spaces on dental professional students?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe elements of the Population Concept(s) Context (PCC) Framework were used to develop the primary and secondary research questions.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eThe eligibility criteria for the inclusion or exclusion of sources of evidence for this scoping review are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. To minimise bias, no date or language limitations were set.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINCLUDE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEXCLUDE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Undergraduate (or pre-doctoral) students undertaking dentistry, dental therapy, dental hygiene, dental nursing or clinical dental technology.\u003c/p\u003e\u003cp\u003e\u0026bull; Recent graduates providing retrospective information about their undergraduate programme.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026bull; Postgraduate students undertaking further specialty training or research programmes.\u003c/p\u003e\u003cp\u003e\u0026bull; Qualified dental professionals undertaking Continuing Professional Development (CPD) or additional training.\u003c/p\u003e\u003cp\u003e\u0026bull; Faculty staff undertaking further education or training.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConcept\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLearning space\u003c/b\u003e: The physical or virtual spaces in which learning and practice occurs, \u003csup\u003e7\u003c/sup\u003e including;\u003c/p\u003e\u003cp\u003e\u0026bull; Physical component: \u0026ldquo;includes brick-and-mortar campus-based teaching and learning buildings, hospitals and clinics, and community sites\u0026rdquo; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u0026bull; Virtual component: \u0026ldquo;electronic learning environments, curriculum management tools, and digital assistants that deliver content to learners and provide forums (sic) for interaction and learning\u0026rdquo; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiterature which pertains to the broader concept of a \u0026lsquo;learning environment\u0026rsquo; without sufficient reference to physical or virtual spaces. Such research may be more concerned with the personal, social or organisational components of the learning environment, for example:\u003c/p\u003e\u003cp\u003e\u0026bull; Teaching or assessment practice or methods\u003c/p\u003e\u003cp\u003e\u0026bull; Curricular development\u003c/p\u003e\u003cp\u003e\u0026bull; Didactic content\u003c/p\u003e\u003cp\u003e\u0026bull; Pedagogical issues\u003c/p\u003e\u003cp\u003e\u0026bull; Student, staff or patient demographics\u003c/p\u003e\u003cp\u003e\u0026bull; Regulatory standards\u003c/p\u003e\u003cp\u003e\u0026bull; Social or healthcare policy\u003c/p\u003e\u003cp\u003e\u0026bull; Clinical guidelines\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMethods of evaluation\u003c/b\u003e which relate to the physical or virtual aspects of learning spaces, including but not limited to:\u003c/p\u003e\u003cp\u003e\u0026bull; Specific instruments which include explicit questions on learning spaces, or which allude to the material component of learning environment e.g., Dental Clinical Learning Environment Instrument (DECLEI), Health Education Learning Environment Survey (HELES), Dental Hygiene Student Learning Climate Survey (DHS-LCS), Ambulatory Care Learning Education Environment Measure (ACLEEM) and the Learning Space Rating System (LSRS).\u003c/p\u003e\u003cp\u003e\u0026bull; Other quantitative assessment tools e.g., questionnaires.\u003c/p\u003e\u003cp\u003e\u0026bull; Qualitative assessment using interviews or focus groups.\u003c/p\u003e\u003cp\u003e\u0026bull; Pre-post studies\u003c/p\u003e\u003cp\u003e\u0026bull; Feedback from students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMethods of evaluation\u003c/b\u003e which do not relate to the physical or virtual aspects of learning spaces:\u003c/p\u003e\u003cp\u003e\u0026bull; The Dundee Ready Education Environment Measure (DREEM) and the Dental Student Learning Environment Survey (DSLES).\u003c/p\u003e\u003cp\u003e\u0026bull; Evaluation by teaching staff of their own performance, including teaching and assessment methods.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImpact\u003c/b\u003e will be considered as an effect on students which can be directly or indirectly linked to the learning space. Effects may include, but are not limited to:\u003c/p\u003e\u003cp\u003e\u0026bull; Acquisition of, or change in, knowledge, skills, attributes or confidence.\u003c/p\u003e\u003cp\u003e\u0026bull; Attainment of competences, defined as \u0026ldquo;professional behaviours and skills required by a graduating dentist in order to respond to the full range of circumstances encountered in general professional practice\u0026rdquo; [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e], or learning outcomes, defined as \u0026ldquo;a series of individual and objective outcomes, with shared ownership between students and staff, designed to facilitate the learning and assessment process\u0026rdquo; [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u0026bull; Change in learner perceptions (or teacher perception of student-centred outcomes).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAny effect on students perceived to result from changes to personal, social or organisational components of the learning environment i.e., not related to physical or virtual learning spaces.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContext\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Undergraduate dental professional programme delivered within university, hospital or community settings.\u003c/p\u003e\u003cp\u003e\u0026bull; Participating in clinical training, placement, rotation, or any interaction with patients.\u003c/p\u003e\u003cp\u003e\u0026bull; Any country\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026bull; Dental specialty training programmes\u003c/p\u003e\u003cp\u003e\u0026bull; Vocational training\u003c/p\u003e\u003cp\u003e\u0026bull; Graduate internships\u003c/p\u003e\u003cp\u003e\u0026bull; Mentoring programmes\u003c/p\u003e\u003cp\u003e\u0026bull; Pre-clinical aspects of dental programmes, for example, biomedical science teaching or practical courses in teaching laboratories.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEvidence Sources\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Peer-reviewed primary research.\u003c/p\u003e\u003cp\u003e\u0026bull; Peer-reviewed evidence synthesis studies (systematic, scoping reviews).\u003c/p\u003e\u003cp\u003e\u0026bull; Grey literature (dissertations, conference papers or proceedings, websites, institutional or government documents or reports, accrediting organisations\u0026rsquo; regulatory standards)\u003c/p\u003e\u003cp\u003e\u0026bull; Expert opinion sources (literature reviews, discussion papers).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026bull; Book and film reviews\u003c/p\u003e\u003cp\u003e\u0026bull; Newspaper articles\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePublication Dates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo limitations will be set.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo limitations\u0026nbsp;will be set.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnglish translation not available.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eThe inclusion and exclusion criteria for this scoping review were aligned with the Population Concept Context (PCC) Framework. No date or language limitations were set.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eA comprehensive search strategy was developed under the guidance of a research librarian, and deployed in the following databases; MEDLINE, Education Full Text, ERIC, Academic Search Complete, Embase, Wiley Online Library, Web of Science Core Collection and Scopus. Subject headings were used for general concepts, combined with keyword searches within titles and abstracts. Additional File 1 contains an example of a draft search strategy for the Embase database. The database searches were undertaken from inception to 19 December 2024, apart from Education Full Text which was not accessible to the reviewers after 2023. The reference lists of full text sources selected for inclusion were screened for additional records. Key authors were contacted to request potentially relevant sources. Key journals, including the European Journal of Dental Education, the Journal of Dental Education and the Journal of Learning Spaces, were hand searched.\u003c/p\u003e\u003cp\u003eSources of grey literature were identified by searching the ProQuest Dissertations \u0026amp; Theses A\u0026amp;I database, the GreyGuide Repository, the DANS Archive and Google Scholar. The websites of the Association for Dental Education in Europe (ADEE), the American Dental Education Association (ADEA) and EDUCAUSE (a non-profit association committed to advancing higher education) were reviewed for relevant content. The conference proceedings of the annual scientific meetings from 2012 to 2024 of both ADEE and ADEA were hand searched.\u003c/p\u003e\n\u003ch3\u003eEvidence Selection\u003c/h3\u003e\n\u003cp\u003eThe citation details of the records contained in the search results were collated in EndNote\u0026trade; Version X9.3.3 (Clarivate Analytics, PA, USA). The reference set was de-duplicated, prior to exporting to Rayyan (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rayyan.ai/\u003c/span\u003e\u003cspan address=\"https://www.rayyan.ai/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), a web-based software platform for management of collaborative evidence reviews [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe process of evidence selection was based on the eligibility criteria (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), aided by a definitions and elaboration document. Screening of the titles and abstracts of the reference set was undertaken by two of the authors, working independently using \u0026lsquo;blind\u0026rsquo; mode in Rayyan, with periodic meetings to resolve any conflicting decisions. Full-text examination of potentially relevant sources was undertaken independently by both reviewers, and any conflicts were resolved by consensus discussion.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Extraction and Analysis\u003c/h2\u003e\u003cp\u003eData extraction was undertaken using a structured charting table, which was aligned with the review objectives, questions and eligibility criteria. One reviewer extracted data for each included source, which was verified by the second reviewer. Basic frequency statistics were used to summarise the data, and the concepts under evaluation were categorised.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eSearch Results\u003c/h2\u003e\u003cp\u003eThe selection process is illustrated using an adapted PRISMA 2020 flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Following de-duplication, a total of 997 records were identified though database searches, hand searching of key journals, contacting relevant authors, and from the grey literature. After screening and assessment of eligibility, a total of 22 full text sources were identified for inclusion. The reasons for exclusion of potential sources at the full-text review stage are documented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eOverview of the Evidence\u003c/h2\u003e\u003cp\u003eA detailed summary of each of the included sources, listed in chronological order, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, which responds to the primary and secondary research questions. Research in this field has been conducted globally, with the greatest number of contributions from the United States of America (USA) and the United Kingdom (UK), respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eSummary of included sources\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSource Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDescription of Participants\u003c/p\u003e\u003cp\u003e▫ Sample size\u003c/p\u003e\u003cp\u003e▫ Dental programme\u003c/p\u003e\u003cp\u003e▫ Year of study\u003c/p\u003e\u003cp\u003e▫ Age\u003c/p\u003e\u003cp\u003e▫ Gender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eConcept under Evaluation\u003c/p\u003e\u003cp\u003e▫ Type of learning space(s)\u003c/p\u003e\u003cp\u003e▫ Aspect(s) of learning space being investigated\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eContext\u003c/p\u003e\u003cp\u003e▫ Country\u003c/p\u003e\u003cp\u003e▫ Setting\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMethods\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eKey Findings Related to:\u003c/p\u003e\u003cp\u003e▫ Learning spaces\u003c/p\u003e\u003cp\u003e▫ Evidence of impact on students\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCraddock [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOutreach Teaching \u0026ndash; the Leeds Experience: Reflections after One Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48 of 55 final year dental students.\u003c/p\u003e\u003cp\u003eAge and gender not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePurpose-built outreach dental clinic.\u003c/p\u003e\u003cp\u003eTwo question items related to students\u0026rsquo; opinions of the clinical facilities and the materials provided.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOutreach facility in Bradford, UK, linked to Leeds Dental Institute.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNarrative description of outreach teaching by the author.\u003c/p\u003e\u003cp\u003eStudent feedback questionnaire administered at the end of the outreach placement.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStudent feedback indicated that they appreciated the facilities and materials provided.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSaito \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLearning Climate in Dental Hygiene Education: A Longitudinal Case Study of a Japanese and Canadian Programme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e402 2nd and 3rd year dental hygiene students participated over a four-year period.\u003c/p\u003e\u003cp\u003eAge and gender not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThe specific learning spaces in these programmes are not described.\u003c/p\u003e\u003cp\u003eItem 1 of the questionnaire related to physical environment, described as \u0026lsquo;the quality of space and privacy afforded to people, the accessibility of necessary supplies and the equipment and supplies available for client care or simulations.\u0026rsquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTwo dental hygiene programmes in a Japanese hygiene college and a Canadian community college.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDevelopment and use of a survey instrument with ten dimensions relating to learning climate - the Dental Hygiene Student Learning Climate Survey.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCanadian students tended to rate the physical environment more favourably.\u003c/p\u003e\u003cp\u003eImprovement of physical working space conditions was put forward by the students as a recommendation within the study. Improved scores were obtained for Item 1 over the study period.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnderson \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUndergraduate Dental Education in New Zealand: 2007\u0026ndash;2009 Final Year Student Feedback on Clinical Learning Environments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFinal year dental students:\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;33 of 68 in 2007;\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;71 of 71 in 2008;\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;52 of 68 in 2009.\u003c/p\u003e\u003cp\u003eAge and gender not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding the learning spaces was provided, however the authors indicate that clinical training occurs almost entirely within the Dental School.\u003c/p\u003e\u003cp\u003eStudents were asked to reflect on their learning experiences within clinical learning environments.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFaculty of Dentistry, University of Otago, Dunedin, New Zealand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eA clinical learning environment survey with quantitative and qualitative components, specific to the Faculty of Dentistry.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStudents' feedback tended to focus on affective aspects of the learning environment rather than physical characteristics. The key role of teaching staff in \u0026lsquo;shaping these environments\u0026rsquo; was highlighted. Suggestions for improving physical aspects included updating facilities, providing more space and chairs, and providing access to more materials.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSch\u0026ouml;nwetter \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAssessing Graduating Dental Students\u0026rsquo; Competencies:\u003c/p\u003e\u003cp\u003eThe Impact of Classroom, Clinic and Externships Learning\u003c/p\u003e\u003cp\u003eExperiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e97 graduating dental students, recruited over five consecutive years, from 2005\u0026ndash;2009.\u003c/p\u003e\u003cp\u003e39 female;\u003c/p\u003e\u003cp\u003e57 male;\u003c/p\u003e\u003cp\u003eone participant chose not to indicate gender.\u003c/p\u003e\u003cp\u003eMean age: 27.7 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThe three learning environments included the classroom, clinic and community service experience (or externship).\u003c/p\u003e\u003cp\u003eNo further details are provided regarding each of these learning spaces.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFaculty of Dentistry, University of Manitoba, Canada\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eThe Graduating Dental Students Competency Assessment Questionnaire was administered.\u003c/p\u003e\u003cp\u003eQuestionnaire evaluated self-reported confidence and perceived importance of 50 competencies, and students\u0026rsquo; perception of the contribution of three learning environments in competency preparation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe university clinical setting was the environment which students believed had the greatest influence on the attainment of competencies.\u0026nbsp;This was followed by classroom and community service settings.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKossioni \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe Development and Validation of a Questionnaire to Measure the Clinical Learning Environment for Undergraduate Dental Students (DECLEI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e202 dental students:\u003c/p\u003e\u003cp\u003e153 4th and 5th year dental students;\u003c/p\u003e\u003cp\u003e49 of 51 students attending a European conference.\u003c/p\u003e\u003cp\u003e119 female;\u003c/p\u003e\u003cp\u003e69 male;\u003c/p\u003e\u003cp\u003e14 did not report their gender.\u003c/p\u003e\u003cp\u003eMean age: 22.4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding learning spaces was provided except to indicate that the majority of participants attended Athens Dental School.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAthens Dental School, Greece\u003c/p\u003e\u003cp\u003eStudents from the UK, Sweden, Romania,\u003c/p\u003e\u003cp\u003eSlovakia, Portugal, Slovenia, Turkey, France, Ireland and Serbia also participated.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eContent development and validation of a new questionnaire, the Dental Clinical Learning Environment Instrument (DECLEI).\u003c/p\u003e\u003cp\u003eThe final instrument included 24 items divided into three domains.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eResulted in 24-item survey in three domains.\u003c/p\u003e\u003cp\u003eThree questions related to physical spaces were retained; clinical infrastructure, use of up-to-date materials and equipment and speed of addressing technical problems with units.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadford and Hellyer [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBelongingness in Undergraduate\u003c/p\u003e\u003cp\u003eDental Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76 of 80 final year dental students\u003c/p\u003e\u003cp\u003eAge and gender not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDental students\u0026rsquo; experience of a residential outreach placement, specifically focusing on the concept of belongingness, and how this related to their development as practitioners.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eThe University of Portsmouth Dental Academy, UK \u0026ndash; an \u0026lsquo;outreach dental clinic\u0026rsquo;. Dental students from Kings College London Dental Institute participated in a residential placement, which is integrated with dental nursing, hygiene and therapy students from the local university.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eQuestionnaire with two quantitative and two qualitative questions, with the latter generating free text responses for subsequent thematic content analysis.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eIn the qualitative data, the physical environment was identified as a sub-theme of the clinical environment theme.\u003c/p\u003e\u003cp\u003eParticipants highlighted the facilities, equipment, and the clinical bays in their responses to questions regarding belongingness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHalawany \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eApplication of the European-Modified Dental Clinical Learning Environment Inventory (DECLEI) in Dental Schools in Riyadh, Saudi Arabia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e613 of 1178 4th and 5th year dental students\u003c/p\u003e\u003cp\u003e302 female;\u003c/p\u003e\u003cp\u003e311 male;\u003c/p\u003e\u003cp\u003eMale and female students were segregated in each of the institutions.\u003c/p\u003e\u003cp\u003eMean age: 23.7 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information provided on specific clinical learning spaces, but all students experienced both school-based clinics and community-based services.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTwo public and two private dental schools in Riyadh, Saudi Arabia.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eThe DECLEI questionnaire used, which was piloted and validated for the student population in this study. The resulting modifications to the questionnaire related to sequencing of questions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSignificant differences noted between student responses at public and private schools for each of the three questions related to learning spaces, with private schools receiving higher ratings.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKrois \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreliminary Validation of an Instrument to assess Students\u0026rsquo; Perceptions of Clinical Learning Environments at U.S. Dental Schools\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e144 3rd and 4th year dental students.\u003c/p\u003e\u003cp\u003eAge and gender not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding the specifics of the learning spaces experienced by these students at this survey validation stage.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUniversity of Iowa College of Dentistry, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePreliminary validation of 24-item DECLEI questionnaire in a single dental school in the United States.\u003c/p\u003e\u003cp\u003eRelevance and content validity were assessed. Principal Component Analysis was used as part of the process.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18 of the initial 24 items were grouped into five domains, one of which was \u0026lsquo;Equipment and Patient Issues\u0026rsquo;. The DECLEI questions on materials, equipment and technical support for units were retained, whilst the question on clinical infrastructure was removed.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSethi and Khan [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIs the Dental Clinical Learning Environment Suitable? A Survey of Khyber Pakhtunkhwa, Pakistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e553 respondents, including 298 undergraduate dental students in clinical years (3rd and final year); the remainder were postgraduate dentists.\u003c/p\u003e\u003cp\u003e345 female;\u003c/p\u003e\u003cp\u003e208 male.\u003c/p\u003e\u003cp\u003eMean age not reported, majority under 25 years.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information on\u003c/p\u003e\u003cp\u003ethe specific learning environment however the authors indicate that the public college was centrally located to facilitate access for patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOne public and two private dental colleges in one province in Pakistan.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24-item DECLEI questionnaire was administered. The questionnaire was first validated by three \u0026lsquo;experts\u0026rsquo; and then piloted (n\u0026thinsp;=\u0026thinsp;10). Some terms were changed to adhere to local contexts.\u003c/p\u003e\u003cp\u003eA section for free-text comments was added to the questionnaire.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe responses indicated that students in private colleges rated their clinical infrastructure, materials and equipment, and technical support for the dental units more highly than their peers in the public college.\u003c/p\u003e\u003cp\u003eBased on these results, the authors recommended improving the infrastructure of the public colleges.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDental Students\u0026rsquo; and Staff Perceptions of the Impact of Learning Environment Disruption on their Learning and Teaching Experiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e296 students responded to the survey;\u003c/p\u003e\u003cp\u003e13 students participated in focus groups;\u003c/p\u003e\u003cp\u003e4 students participated in individual interviews.\u003c/p\u003e\u003cp\u003eDental, dental therapy and dental technician students were represented.\u003c/p\u003e\u003cp\u003eAge and gender not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThe clinical facilities in which patient care was delivered, the school library and non-clinical teaching spaces were included.\u003c/p\u003e\u003cp\u003eThis iteration of the annual survey specifically explored the impact of disruptions to the physical learning environment on students\u0026rsquo; learning and staff teaching experiences, e.g., limited space availability, noise and hazardous demolition work.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFaculty of Dentistry, University of Otago, Dunedin, New Zealand, during a period of major building redevelopment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAn annual, online, feedback survey\u0026nbsp;was tailored to include the question, \u0026lsquo;Do you have any comments regarding your teaching and learning facilities?\u0026rsquo;.\u003c/p\u003e\u003cp\u003eand learning facilities?\u0026rsquo;\u003c/p\u003e\u003cp\u003eData was also collected via interviews and focus groups.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStudents placed greater value on staff contributions than the physical learning environment.\u003c/p\u003e\u003cp\u003eDespite temporary physical constraints, a positive academic environment was created by the people in the Dental School.\u003c/p\u003e\u003cp\u003eThe results of the focus groups and interviews indicated that the physical environment, people and relationships were intertwined.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKrois \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSteps Towards Validation of the Dental Education Clinical Learning Instrument (DECLEI) in American Dental Schools (DECLEI-USA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e286 dental students in 3rd and 4th year\u003c/p\u003e\u003cp\u003eGender partially reported as:\u003c/p\u003e\u003cp\u003e156 female;\u003c/p\u003e\u003cp\u003e125 male.\u003c/p\u003e\u003cp\u003eAge not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding the specifics of the learning spaces experienced by these students as part of this validation exercise.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUniversity of Iowa College of Dentistry and University of Texas Health Science Centre, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eFurther validation of 24-item DECLEI questionnaire in a two dental schools.\u003c/p\u003e\u003cp\u003eTwo approaches were used for validation, Regression Model and Item-Total Correlation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eDeveloped 9-item Mini DECLEI-USA, in which the questions on clinical infrastructure, and use of up-to-date materials and equipment were retained.\u003c/p\u003e\u003cp\u003eThe authors also proposed a 20-item DECLEI-USA, in which the question on speed of addressing technical problems with units was retained.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLau \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDental Students\u0026rsquo; Perceptions of Learning Space: A Focus Group Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 recent dental graduates.\u003c/p\u003e\u003cp\u003e12 female;\u003c/p\u003e\u003cp\u003e4 male.\u003c/p\u003e\u003cp\u003eMean age: 24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eParticipants\u0026rsquo; feedback was sought on orthodontic learning spaces for lectures, tutorials, clinics, self-study and networking. The students were asked about the \u0026lsquo;space and infrastructure\u0026rsquo; provided for these activities.\u003c/p\u003e\u003cp\u003eThe clinical learning spaces were identified as clinics used for multidisciplinary treatment planning. There was limited information regarding the physical parameters of the clinic.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFaculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTwo focus group discussions were undertaken with eight students in each group. The participants were allocated to the groups based on grades; Group 1 participants had higher grades and Group 2 had lower grades.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe findings indicate that the students\u0026rsquo; learning experiences are impacted by a perception of \u0026lsquo;crowding\u0026rsquo;. Some students felt that the interactions between clinician and patients were affected by the presence of too many students.\u003c/p\u003e\u003cp\u003eSuggestions for improvement included adjusting the ratio of students to patients, or setting up an interactive, moderated, live-streaming session in a separate location.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAli \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe Perception of Undergraduate Dental Students Toward a Clinical Learning Environment at School of Dentistry and Oral Health, Fiji National University, Fiji\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e130 of 157 undergraduate students with clinical experience:\u003c/p\u003e\u003cp\u003eDental Hygiene (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003cp\u003eBachelor of Oral Health (n\u0026thinsp;=\u0026thinsp;58) Dentistry (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\u003cp\u003e94 female;\u003c/p\u003e\u003cp\u003e36 male.\u003c/p\u003e\u003cp\u003eAge range: 19\u0026ndash;43 years, with majority aged from 20\u0026ndash;29 years.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding the specifics of the clinical spaces, however the authors indicate that the University dental clinics are new, with contemporary materials and equipment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSchool of Dentistry and Oral Health, University of Fiji\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eThe 24-item DECLEI questionnaire was administered.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eIn relation to the relevant DECLEI questions for this review;\u003c/p\u003e\u003cp\u003e\u0026lsquo;Clinical infrastructure\u0026rsquo; was rated as excellent;\u003c/p\u003e\u003cp\u003e\u0026lsquo;Using up-to-date materials and equipment\u0026rsquo; and \u0026lsquo;technical problems being dealt with quickly\u0026rsquo;, were rated as good.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKrois \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreliminary Validation of the Dental Clinical Learning Environment Instrument in a Brazilian Dental School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e155 of 169 dental students in 7th and 8th semester of a 10-semester programme, all of whom had at least 1 year of clinical experience.\u003c/p\u003e\u003cp\u003e106 female;\u003c/p\u003e\u003cp\u003e49 male.\u003c/p\u003e\u003cp\u003eMean age: 23.9 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding the specifics of the learning spaces experienced by these students as part of this validation exercise.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eThe Dental School at the Federal University of Pelotas, Brazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePreliminary validation of the 24-item DECLEI questionnaire in a single dental school in Brazil.\u003c/p\u003e\u003cp\u003eRelevance and content validity were assessed. Principal Component Analysis was used as part of the validation process.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eA 17-item DECLEI questionnaire was proposed, in which the questions related to clinical infrastructure, materials and equipment, and technical support for the dental units were retained.\u003c/p\u003e\u003cp\u003eThe authors highlighted the challenges of validating learning environment instruments in different cultures.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNath \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe Outcome of a New Teledentistry Initiative in Response to the COVID-19 Pandemic: A Cross-sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e200 of 266 3rd and 4th year dental students.\u003c/p\u003e\u003cp\u003e96 female;\u003c/p\u003e\u003cp\u003e101 male;\u003c/p\u003e\u003cp\u003eGender not disclosed by 3 participants.\u003c/p\u003e\u003cp\u003eAge not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTeledentistry sessions, termed \u0026lsquo;eVisits\u0026rsquo;, were held in a conference room, with a group of eight to nine students, supervised by a\u003c/p\u003e\u003cp\u003efaculty member.\u003c/p\u003e\u003cp\u003eClinical engagement with patients took place using the Google Voice app supported by software to record the interaction.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAn educational teledentistry initiative at the\u003c/p\u003e\u003cp\u003eLoma Linda University School of Dentistry, California, USA.\u003c/p\u003e\u003cp\u003eThe study was carried out against the backdrop of the COVID-19 pandemic.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eA 9-item survey, with three sections as follows:\u003c/p\u003e\u003cp\u003eTwo demographic questions;\u003c/p\u003e\u003cp\u003eSix questions on perceived teaching effectiveness;\u003c/p\u003e\u003cp\u003eOne open-ended question.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe majority believed that the university was providing a good educational environment by initiating teledentistry sessions and that their communication skills had improved.\u003c/p\u003e\u003cp\u003eOver half of the students felt that their ability to perform oral evaluation had improved because of participation.\u003c/p\u003e\u003cp\u003eThe free-text responses included a suggestion to incorporate a video component, and acknowledgement of background noise as a barrier to communication.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePellicer \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTransformation of a University Educational Space through Musical Flow on Undergraduate Dental School Students during the COVID-19 Pandemic: A Pilot Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e119 of 135 5th year dental students.\u003c/p\u003e\u003cp\u003e69 female;\u003c/p\u003e\u003cp\u003e50 male\u003c/p\u003e\u003cp\u003eAge range: majority aged from 21\u0026ndash;25 years.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWithin a polyclinic environment, ambient music was played from a computer in each \u0026lsquo;office\u0026rsquo;, at a constant average volume (\u0026le;\u0026thinsp;60db), whilst students were treating patients. Each student was able to select their own preferred music.\u003c/p\u003e\u003cp\u003eThere is limited information regarding the physical parameters of the clinic.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDepartment of Clinical Dentistry at the private European University of Madrid, Spain.\u003c/p\u003e\u003cp\u003eThe study was carried out against the backdrop of the COVID-19 pandemic.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eExperimental study with intervention (n\u0026thinsp;=\u0026thinsp;63) and control (n\u0026thinsp;=\u0026thinsp;56) groups. The intervention group listened to music, whilst the control group did not.\u003c/p\u003e\u003cp\u003eData was gathered via a questionnaire and a visual analogue scale, which was used to measure level of anxiety before and after treating a patient.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAll students were less anxious after treatment, with those who listened to music experiencing a greater reduction in anxiety.\u003c/p\u003e\u003cp\u003e86% of the intervention group\u0026nbsp;considered music to be a useful tool to reduce anxiety.\u003c/p\u003e\u003cp\u003e89% of this group also believed that listening to music improved their clinical work.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoss and Holder [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDental Undergraduate Students' Perceptions about Placements in Primary Dental Care during the Undergraduate Dental Curriculum: A Qualitative Evidence Synthesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThe majority of included studies reported on data from undergraduate dental students in 4th and 5th year. Two further studies related to students post-qualification.\u003c/p\u003e\u003cp\u003eParticipant numbers ranged from five to 320, with some studies taking place longitudinally, encompassing data from up to five academic years.\u003c/p\u003e\u003cp\u003eLimited demographic data available.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStudents participated in a primary dental care placement away from the teaching hospital setting.\u003c/p\u003e\u003cp\u003eThe format varied from school to school, and included both general dental practice and purpose-built outreach centres.\u003c/p\u003e\u003cp\u003eThe review aimed to explore the perceptions of undergraduate dental students in the UK on their placements in primary\u0026nbsp;care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUndergraduate programmes\u0026nbsp;from seven different UK dental schools.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eA Qualitative Evidence Synthesis\u0026nbsp;approach was utilised, which incorporated a database search in addition to contacting all UK dental schools for details of evaluations of primary care placements.\u003c/p\u003e\u003cp\u003eThe Critical Skills Appraisal Programme qualitative study framework was used to appraise studies and a narrative synthesis approach was used to describe the data.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11 studies were selected for inclusion, with date of publication ranging from 2004 to 2019.\u003c/p\u003e\u003cp\u003eThe physical attributes of the learning environment had varying effects.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePositive impacts\u003c/em\u003e:\u003c/p\u003e\u003cp\u003ePreparation of the surgery allowed students to relax and enhanced their learning experience; Access to a kitchen made the students feel part of a team;\u003c/p\u003e\u003cp\u003ePlacement was a \u0026lsquo;true representation\u0026rsquo; of the practice environment, helping graduates to settle into their post after graduation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eNegative impact\u003c/em\u003e:\u003c/p\u003e\u003cp\u003eProblems with missing or faulty equipment had a detrimental effect.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShehada \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMajor Stress Sources Amongst Dental Students at Damascus University, Syria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e365 of 2534 dental students in 3rd (n\u0026thinsp;=\u0026thinsp;95), 4th (n\u0026thinsp;=\u0026thinsp;133) and 5th (n\u0026thinsp;=\u0026thinsp;138) year.\u003c/p\u003e\u003cp\u003e212 female;\u003c/p\u003e\u003cp\u003e153 male.\u003c/p\u003e\u003cp\u003eAge range: 20\u0026ndash;24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information regarding the clinical learning spaces is provided, however the authors indicated that the university was greatly lacking in teaching staff, dental materials and equipment.\u003c/p\u003e\u003cp\u003e\u0026lsquo;Lack of dental equipment\u0026rsquo; was considered a source of stress for students.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFaculty of Dentistry, Damascus University, Syria.\u003c/p\u003e\u003cp\u003eThe authors reference the so-called \u0026lsquo;Arab Spring\u0026rsquo; which took place in the early 2010s and has led to ongoing disruption in Syria.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eA modified 29-item version of the Dental Environment Stress (DES) questionnaire was administered following translation into Arabic, validation and pre-testing.\u003c/p\u003e\u003cp\u003eA question item related to dental equipment was added following recommendation from pre-testing.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe lack of dental equipment was identified as the single factor which caused the most stress.\u003c/p\u003e\u003cp\u003eThe authors suggest that students may not be adequately prepared to enter the workforce if they have not trained with high quality, modern dental equipment during the clinical phase of their education.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJaved \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUndergraduate Students\u0026rsquo; and Interns\u0026rsquo; Perception towards Learning Environment at Dental Clinics, Qassim University, Saudi Arabia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87 of 111 4th and 5th year dental students and interns, with 5th years accounting for the majority of responses (42.5%).\u003c/p\u003e\u003cp\u003e49 female;\u003c/p\u003e\u003cp\u003e38 male.\u003c/p\u003e\u003cp\u003eAge not reported.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information available regarding the specifics of the clinical spaces.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCollege of Dentistry, Qassim University, Saudi Arabia.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eThe 24-item DECLEI questionnaire was administered.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eIn relation to the relevant DECLEI questions for this review, \u0026lsquo;clinical infrastructure\u0026rsquo;, \u0026lsquo;use of up-to-date materials and equipment\u0026rsquo;, and \u0026lsquo;technical problems being dealt with quickly\u0026rsquo;, were rated as good.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAkinpelu \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Students\u0026rsquo; Perception of Educational Environment in a Nigerian University: A Mixed Method Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e223 final year students in clinical programmes; nursing, medicine, physiotherapy and dentistry (n\u0026thinsp;=\u0026thinsp;28).\u003c/p\u003e\u003cp\u003e13 female;\u003c/p\u003e\u003cp\u003e15 male.\u003c/p\u003e\u003cp\u003eMean age: 25 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLimited information available regarding the clinical learning spaces in the dental programme.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eThe College of Medicine at The University of Ibadan, Oyo, Nigeria.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMixed methods study in which students completed the Dundee Ready Education Environment Measure questionnaire, followed by a qualitative component.\u003c/p\u003e\u003cp\u003eFour focus groups representing each of the clinical programmes were conducted with six students in each.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe findings in relation to learning spaces for dental education formed a relatively small component of the overall study. One of the themes identified in the qualitative data related to infrastructure and facilities. Students felt that they did not have ready access to appropriate equipment and facilities.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMcCormick \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvaluation of a Student Telehealth Rotation at the Columbia\u003c/p\u003e\u003cp\u003eUniversity College of Dental Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e89 of 95 3rd year dental students.\u003c/p\u003e\u003cp\u003eNo demographic data provided.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEvaluation of a week-long telehealth rotation involving virtual interaction with patients on Zoom meetings. A group of two to three students each joined from their own computer and were supervised by a faculty member. The virtual visits include history and visual assessment with the patient using the camera on their device.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eA telehealth rotation at Columbia University College of Dental Medicine, New York, USA.\u003c/p\u003e\u003cp\u003eThe rotation was introduced following the onset of the COVID-19 pandemic.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCompletion of a post-rotation evaluation on a digital learning platform. Students were asked to respond qualitatively to five open-ended questions, of which three related to evaluation of the telehealth rotation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStudents reported improvements in clinically relevant skills and knowledge, which the authors suggest implies that telehealth rotations can supplement traditional clinical dental education and reinforce concepts essential to patient care.\u003c/p\u003e\u003cp\u003eStudents reported that the main challenge was technology issues, in particular patient access, or visual limitations during the exam.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOderinu \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExploring Dental Students\u0026rsquo; Perceptions of their Clinical Learning Environment: A Qualitative Study to Evaluate the Curriculum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeer-reviewed journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 5th and 6th year dental students.\u003c/p\u003e\u003cp\u003e9 female;\u003c/p\u003e\u003cp\u003e7 male.\u003c/p\u003e\u003cp\u003eAge range: 21\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAn evaluation of student experiences within the clinical learning environment of various specialty-based dental departments in a tertiary hospital setting.\u003c/p\u003e\u003cp\u003eThe student experience of learning within the dental clinics, along with suggestions for improvements, were the subject of the investigation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFaculty of Dental Sciences of the College of Medicine, University of Lagos, Nigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eA qualitative approach was undertaken, with four focus group discussions involving four students in each group.\u003c/p\u003e\u003cp\u003eThe focus group schedule consisted of four open questions, followed by specific questions to explore positive and negative aspects of student experience.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eA recent upgrade to the equipment and facilities was identified as an enabler of learning in the dental clinics.\u003c/p\u003e\u003cp\u003eOn the other hand, non-availability of required dental materials and inadequate environmental cooling of clinical spaces were identified as barriers to learning.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eData was extracted from each included source using structured headings as shown in this table. The headings were designed to align with the primary and secondary research questions.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eKey aspects of the included sources, including year of publication, relevant student population, type of learning space and study design, are summarised in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The number of publications per year appears to be trending upwards (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). The majority of studies involved dental students, with one study including dental hygiene students only [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and two studies including combinations of students from different programmes (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTypes of Dental Learning Spaces\u003c/h2\u003e\u003cp\u003eThe majority of learning spaces under investigation were clinical facilities located within individual universities or dental schools (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). All three of the studies from the UK were concerned with evaluation of student experiences of dedicated outreach facilities or placements with primary dental care settings [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. A multi-site study related to two dental hygiene programmes in Canada and Japan explored students\u0026rsquo; opinions of a variety of college-based and off-site settings [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Classroom, clinics and community service settings were compared in a Canadian study assessing students\u0026rsquo; self-reported confidence to carry out defined competencies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Two studies, based in Pakistan and Saudi Arabia, compared dental students\u0026rsquo; perception of the clinical learning environment in public and private colleges [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Two studies were concerned with the virtual environment, in which students\u0026rsquo; perceptions of \u0026lsquo;teledentistry\u0026rsquo; initiatives were explored [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eMethods of Evaluation of Dental Learning Spaces\u003c/h2\u003e\u003cp\u003eAll of the included publications related to primary research, with the exception of one qualitative evidence synthesis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Most studies used quantitative approaches to evaluation, with mixed and qualitative methods appearing less frequently (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). Four of the quantitative studies related to development and validation of the Dental Clinical Learning Environment Instrument (DECLEI) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], which was used in four further publications [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The Dental Hygiene Student Learning Climate Survey (DHS-LCS) was used in one of the included publications [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. One study used the Dental Environment Stress (DES) questionnaire, which was modified by addition of a question related to dental equipment [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Pellicer \u003cem\u003eet al.\u003c/em\u003e utilised a pre-post interventional design, assessed via questionnaire and visual analogue scale to measure anxiety [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. A locally developed survey was used for the remaining three quantitative studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The mixed methods designs encompassed questionnaires with quantitative and qualitative elements [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and questionnaires combined with interviews and/or focus groups [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Four qualitative studies were included [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. The majority of studies were conducted at single time points, with three studies taking place longitudinally [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eEvidence Related to Impact\u003c/h2\u003e\u003cp\u003eMost of the included studies sought student opinion or perception of their learning environment in a particular setting (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40 CR41 CR42 CR43 CR44\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Three studies documented the influence of the learning space on student experience within their dental programmes. The \u003cem\u003eet al.\u003c/em\u003e noted that the disruption caused by construction was mitigated by a positive academic environment [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Ross and Holder documented attributes of the learning space which had both positive and negative effects on students during primary dental care placements [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, aspects of the learning space were found to act as both an enabler and a barrier to learning in a Nigerian dental school [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn a further study which explored the relationship between educational setting and preparedness to carry out defined competencies, participants indicated that the setting which was most effective was the university clinic, followed by the classroom, and then community-based clinics, although there was limited information regarding the physical parameters of each context [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, three studies associated learning spaces with an emotional state. The facilities, equipment and clinical bays in a purpose-built primary care facility were highlighted by students in relation to a sense of \u0026lsquo;belongingness\u0026rsquo; during a residential outreach placement [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The findings of an experimental study which investigated the effect of ambient music played during clinical sessions indicated that music may help students to feel less anxious while they are treating patients [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Poor access to dental equipment was a major source of stress for dental students in a Syrian university [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review provides an overview of the available evidence regarding the impact of learning spaces on dental professional students during clinical aspects of their education. The findings indicate that limited research has been conducted on this topic to date. Most of the included studies were conducted in a single centre at one time point.\u003c/p\u003e\u003cp\u003eThe majority of clinical learning spaces were located in university-based dental hospitals or schools. Since a significant proportion of undergraduate experience is often provided in a central school or hospital, this finding was reflective of the pedagogical approach adopted in many dental curricula. In more recent times, an alternative model has emerged, with training provided in community-based settings [\u003cspan additionalcitationids=\"CR52 CR53\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. The development of dental outreach teaching centres to facilitate preparation for independent practice was highlighted in a recent scoping review [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The layout, size and equipment available in a purpose-built, dental outreach centre were well-described by one of the included articles [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In general, however, information regarding the physical aspects of the clinical learning environments was lacking, which inhibits comparison between settings.\u003c/p\u003e\u003cp\u003eIn clinical education research, questionnaires are useful tools for gathering information about abstract ideas or concepts that are otherwise difficult to quantify, such as opinions, attitudes, beliefs or behaviours which are not directly observable [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. On the other hand, these types of studies tend to be limited by the range of questions possible, and the level of detail that can be collected at a single time point [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. There is merit to the longitudinal approach adopted in two of the included studies, which allowed identification of issues and implementation of improvements [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In other studies, questionnaires were used to explore student opinion on a wide variety of diverse issues, from the quality of clinical infrastructure and equipment, to the influence of ambient music or construction on learner experience [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA recent scoping review identified a wide array of questionnaires used to assess student perception of the learning environment in health professions\u0026rsquo; education [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. This can also be seen in dental education with multiple instruments available, however, attention to the physical aspects of learning spaces is limited. The Dundee Ready Education Environment Measure (DREEM), originally developed for medical education, is in widespread use in dental contexts [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. However, this tool does not address learning spaces. Similarly, the Dental Student Learning Environment Survey (DSLES) does not reference learning spaces explicitly [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. On the other hand, the Dental Clinical Learning Environment Instrument (DECLEI) includes questions on materials, equipment, clinical infrastructure and dental units [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Likewise, Item 1 of the Dental Hygiene Student Learning Climate Survey encompasses the \u0026lsquo;quality of space and privacy\u0026rsquo;, and the \u0026lsquo;accessibility of necessary supplies and equipment\u0026rsquo; [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The recently developed Health Education Learning Environment Survey (HELES) also includes statements on technology and quality of the physical environment [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Recently, the Learning Space Rating System (LSRS), developed by EDUCAUSE, has been used in a university medical setting [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. The LSRS is designed to assess the potential of formal and informal spaces to support student learning.\u003c/p\u003e\u003cp\u003eOn the other hand, qualitative research has the potential to enhance our understanding of aspects of teaching and learning by going beyond \u0026lsquo;surface description\u0026rsquo; [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Mixed-method and qualitative approaches, including focus groups, interviews and qualitative evidence synthesis, featured in this review [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Qualitative analysis of student feedback or free-text responses to open-ended questions was also evident [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Within dental education, qualitative methods can be used to explore specific elements of pedagogy and aspects of teaching, learning and assessment, providing an in-depth, contextualised understanding of student experience [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. When evaluating learning environments for inter-professional care, Kvan argues that qualitative data about the learning experience must be collected to provide evidence for the influence of design on learning outcomes [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImpact may be defined as that which occurs as a result of the outcomes of an intervention [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Impacts are best identified through a broad range of evidence which provides robust verification for enhanced knowledge, behaviours and practices, and it should include a mix of qualitative and quantitative data [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. A recent systematic review and meta-analysis used improvements in knowledge, skills and clinical behaviours for health professionals and students as an outcome measure to assess the efficacy of adaptive e-learning environments [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. However, it is acknowledged that identifying the impact of a specific intervention or pedagogical development may be challenging, given the multi-faceted nature of dental education.\u003c/p\u003e\u003cp\u003eIn this scoping review, self-reported improvement in clinical skills in association with the learning space was alluded to in three studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. However, the reliability of these findings is low, since there was no independent verification of the students\u0026rsquo; clinical performance. Furthermore, the information provided about the learning spaces is generally limited, and thus, it is difficult to draw conclusions about the specific impacts of the space in the context of the wider academic environment. In general, evidence of impact of the learning space on dental professional students was limited.\u003c/p\u003e\u003cp\u003eInterestingly, more explicit links to the physical attributes of learning spaces can be seen in an exploration of dental students\u0026rsquo; sense of belongingness, with evidence suggesting that the space, facilities and equipment influenced the students\u0026rsquo; journey towards independent practice [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In a review of primary dental care placements, Ross and Holder also highlighted the learning environment as a key factor in increasing student confidence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Students provided examples from the physical environment, such as the surgery being set up in advance, which helped them to feel relaxed and enhanced their learning [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. However, another study included in this review cited negative aspects of the physical environment, such as missing or faulty equipment, which had a detrimental effect on student experience [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Future Research\u003c/h2\u003e\u003cp\u003eIn the studies included in this review, the role of the student was usually limited to provision of feedback or opinion regarding an aspect of dental education. It is certainly important to consider student views in this manner, and there is consensus in the dental literature that student feedback should be used to inform curricular development [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, there appears to be limited evidence that students are being involved as partners in learning space design.\u003c/p\u003e\u003cp\u003eThe notion of the \u0026lsquo;student voice\u0026rsquo; in relation to dental education is well articulated by Subramanian \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. They argue for greater emphasis on the voice of the student in pedagogical research, by allowing students the opportunity to dynamically influence their learning process and environment [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. This ethos underpins the work of Ebbeling and colleagues, which examined dental student perceptions of their clinical learning environment in order to enhance learning outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Going forwards, an evidence-based approach to learning space design from the perspective of students and teachers would be of benefit to all stakeholders.\u003c/p\u003e\u003cp\u003eGlobally, dental curricula are undergoing reform, due in part to the need to incorporate technological advances, including the digital dentistry workflow [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e], the drive for improved sustainability [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e], and re-orientation of services towards delivery of universal oral healthcare [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. As institutions consider investing in the re-design and re-orientation of new or existing clinical facilities, it is essential that research is embedded within the curriculum to facilitate ongoing investigation of the influence of physical and virtual spaces. Ross and Holder suggest that dental schools should be evaluating their training, doing so in a cohesive way, sharing results, and should consider a longitudinal approach [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eWithin the conceptual framework proposed by Gruppen, learning spaces are encompassed within the broader construct of the learning environment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is acknowledged that the influence of physical and virtual environments are interconnected with Gruppen\u0026rsquo;s psycho-social dimension. As such, the findings of this review regarding learning spaces are not intended to be considered in isolation of the broader educational environment.\u003c/p\u003e\u003cp\u003eA potential limitation of the search strategy relates to the variability in terminology regarding learning spaces and environments. Disciplinary differences may exist with respect to the interpretation of terms such as, \u0026lsquo;learning space\u0026rsquo;, \u0026lsquo;learning environment\u0026rsquo;, \u0026lsquo;learning climate\u0026rsquo;, etc. The review team maintained flexibility in their approach to identification of potential synonyms throughout the source selection process. It was also necessary to place some limits on components of the search strategy e.g., choice of key journals and websites. Consideration was given to the potential relevance, available resources, and applicability to the design of future primary research. Finally, a critical appraisal of the quality of the included studies was not carried out due to the exploratory nature of the scoping review as an evidence synthesis method.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eGiven the unique nature of dental clinical learning spaces, in which patient safety must be balanced with students\u0026rsquo; educational needs, in addition to the high cost of dental education, and accreditation requirements, it is important to take stock of the physical estate of dental schools. The current evidence base​ regarding the impact of learning spaces on dental professional students during clinical training at undergraduate level is limited. Most of the research to date relates to teaching hospital or university settings. Quantitative methods using dental learning environment survey tools are commonly used, albeit with a limited focus on learning spaces. Further research, conducted in partnership with students, is required to support optimal design of clinical facilities in dental education programmes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eJBI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Joanna Briggs Institute JBI\u003c/p\u003e\n\u003cp\u003ePRISMA-ScR \u0026nbsp; \u0026nbsp;Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePCC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Population Concept Context\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDECLEI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dental Clinical Learning Environment Instrument\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHELES \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Health Education Learning Environment Survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDHS-LCS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dental Hygiene Student Learning Climate Survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eACLEEM\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Ambulatory Care Learning Education Environment Measure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLSRS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Learning Space Rating System\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDREEM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dundee Ready Education Environment Measure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDSLES \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dental Student Learning Environment Survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eADEE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Association for Dental Education in Europe\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eADEA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;American Dental Education Association\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDES \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dental Environment Stress\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript and a supplementary information file.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funds were received for this research project.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions\u003c/p\u003e\n\u003cp\u003eSL and BS conceived the idea for this review. SL designed and registered the study protocol. FB critically reviewed the protocol before registration. SL carried out the data searches. SL and KP performed initial and final screening of articles. BS aided in resolution of conflicts during the screening process. All authors were involved in data analysis and review of results. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Ms Virginia Conrick, Academic Success Librarian, University College Cork, for her support in designing the search strategy for this review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; information\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eCork University Dental School and Hospital, University College Cork, Cork, Ireland \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eMarketing and International Business, Munster Technological University, Cork, Ireland \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003csup\u003e3\u003c/sup\u003eSchool of Education, University College Cork, Cork, Ireland \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDivaris K, Barlow PJ, Chendea SA, Cheong WS, Dounis A, Dragan IF, et al. 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Eur J Dent Educ. 2010;14(4):193-202. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental education, dental students, learning space, evidence synthesis, scoping review","lastPublishedDoi":"10.21203/rs.3.rs-7723267/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7723267/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLearning spaces have been defined as physical or virtual spaces in which learning and practice occur. Clinical dental education may take place in a variety of settings, including open and closed surgeries in teaching hospitals, health centres and dental practices. The aim of this scoping review is to map available evidence regarding the impact of learning spaces on undergraduate dental professional students during their clinical training. The secondary objectives are to ascertain how learning spaces in undergraduate dental education are evaluated, to identify potential gaps in knowledge, and to inform future primary research.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis scoping review was conducted in accordance with Joanna Briggs Institute guidance and the PRISMA Extension for Scoping Reviews. An \u003cem\u003ea priori\u003c/em\u003e protocol was developed and registered on the Open Science Framework. The research questions and eligibility criteria were designed using the Population (undergraduate dental professional students), Concept (impact and evaluation of learning spaces), Context (clinical training in physical/virtual environments) Framework. A comprehensive database and grey literature search strategy was developed. Key journals were hand searched and important authors were contacted. Source selection was carried out independently by two reviewers screening titles and abstracts, facilitated by Rayyan, followed by full-text screening of potentially relevant articles. Data was extracted using a structured proforma and summarised descriptively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn total, 2,286 records were identified following deployment of the search strategy. After de-duplication and exclusions, 22 full-text sources were identified for inclusion. Most studies involved dental students only (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19), with combinations of student groups (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2) and hygiene students (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1) appearing infrequently. The majority of learning spaces under investigation were clinical facilities within universities or dental schools. Most studies used learning environment surveys, albeit with a limited focus on learning spaces (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14). Mixed (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4), and qualitative methods (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4), were used less commonly. Student opinion was sought in the majority of studies (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere appears to be limited evidence available regarding the impact of learning spaces on dental professional students. Further collaborative research with all relevant stakeholders is required to support the optimal design of clinical facilities in dental education.\u003c/p\u003e","manuscriptTitle":"The Impact of Learning Spaces in Undergraduate Dental Education: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 09:35:42","doi":"10.21203/rs.3.rs-7723267/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d78f5df-f20a-4217-8642-c8e3acb17d8f","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T09:08:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-03 09:35:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7723267","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7723267","identity":"rs-7723267","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}