Integrating First-Person Smart Glasses Video into Oral and Maxillofacial Surgery Education: A Mixed-Methods Study on Student Learning and Experience

Integrating First-Person Smart Glasses Video into Oral and Maxillofacial Surgery Education: A Mixed-Methods Study on Student Learning and Experience | 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 Integrating First-Person Smart Glasses Video into Oral and Maxillofacial Surgery Education: A Mixed-Methods Study on Student Learning and Experience Muhammed Fatih Çiçek, Ahmet Caymaz, Muhammet Demirkaya, Muhammed Mustafa Sağer, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9457604/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background: Video-based and wearable technologies have the potential to enhance the learning experience by increasing visual access in clinical education, however these technological methods have limited evidence about the effects of observation awareness and learning experience of the interns in the dental clinical internship setting. The aim of this study was to examine the impact of different clinical observation methods used during practical clinical training of implant surgery, which is a minor oral surgical procedure performed in oral and maxillofacial surgery, on students’ clinical learning awareness and experience. Methods: A total of 94 participants from fifth-year dental students were included in the study and separated into three groups as traditional observation group , live video streaming group and hybrid observation (traditional observation + live video streaming) group . Following the observation, a questionnaire comprising qualitative and quantitative data was administered to the groups. Data were collected using a structured questionnaire and open-ended questions that assessed students' observational awareness, learning experiences, and overall perceptions. Quantitative data were analyzed using Fisher’s Exact test (p<0.05), while qualitative data were collected through semi-structured interviews and analyzed using inductive content analysis. Results: The hybrid observation method was found to be significantly more effective than traditional and live video observation in terms of following the sequence of surgical instruments, professional development, decision-making under stress, and observing patient behaviours (p<0.001). In addition, the field of view and the ability to notice details were rated significantly higher in the hybrid and live video observation groups compared with the traditional observation group (p<0.001). Observation from the operating room facilitated the experience of the clinical environment and professional interaction but remained limited in terms of visual access (p<0.001). In contrast, live video observation improved visual clarity but provided a more limited clinical experience (p<0.001). Conclusions: The method of hybrid observation provides students with a more comprehensive and instructive learning experience by integrating the benefits of direct observation of the surgical field with the wider field of view. First-person smart glasses videos have a positive impact on oral and maxillofacial surgery training and students’ education by enhancing the perceptibility of surgical procedures. dental education hybrid learning smart glasses maxillofacial surgery video-assisted learning Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Traditional face-to-face lessons remain an indispensable component of dental education for knowledge transfer ( 1 ). Along with rapid technological advancements digitally supported learning opportunities have improved. This situation has resulted in the integration of traditional learning models and digitally supported learning tools ( 2 ). The digital tools which are integrated in emerging technologies in dental education enhance the capacity of teaching and have emerged as a promising alternative approach. Technological innovations in education and teaching, together with increased student access to electronic resources, have increased the importance of different teaching methods ( 3 , 4 ). Especially voice and video records, virtual reality and methods such as haptic technologies have become an indispensable part of practical skill training in medical and dental education in recent years ( 5 ). These developments facilitate the adoption of new approaches that support and enrich educational models. In practical dental education, video-based training aims to provide students’ competencies in a standardized and efficient manner. This training method is used as an effective tool to improve and enhance the conventional education and to promote long-term retention ( 6 ). Benefits of this training model are specified in terms of teaching practical competencies and their transfer to clinical practice ( 7 , 8 ). Besides video recordings, live monitoring of intraoral procedures represents an additional approach. The effectiveness of the methods of live video instruction and video recording in teaching orthodontic emergency procedures to dental students were compared in a previous study. No statistically significant difference was observed between the two methods with respect to subject knowledge ( 9 ). One of the major limitations of live monitoring in clinical training is that intraoral procedures cannot be viewed by all students from the same perspective and with adequate clarity ( 10 ). Reports addressing the effectiveness and perception of video lectures as a learning tool in health education are promising ( 11 ). Studies have shown that medical students achieve similar test results following both live lectures and video-based instruction; while some students prefer live lectures, others favor video-based learning because it allows them to progress at their own pace and review the content as needed ( 12 , 13 ). Existing studies also reveal certain challenges of video-based educational methods as perceived by students. Students may report being restricted to a single point of view, being unable to observe the working position of the dentist while performing the procedure, being unable to observe the reactions of the patient and experiencing distraction during video viewing. This issue results from passive observation of the educational material, highlighting the disadvantages of this non-interactive, one-way learning model ( 9 , 14 ). One of the most significant disadvantages of the traditional educational model is that, due to limited physical space, students are restricted to viewing intraoral procedures from the perspective of an experienced instructor ( 8 ). This subject becomes more pronounced, particularly in operating room–based procedures such as Oral and Maxillofacial Surgery and may prevent students from clearly observing the surgical field ( 15 ). Therefore educators are seeking new methods and technologies to enable students to observe the surgical field more equitably, more clearly and from a closer perspective. One of the latest technological developments is the use of wearable smart devices ( 15 ). The emergence of hands-free, wearable, interactive technologies such as smart glasses has encouraged researchers to further investigate their potential roles in clinical education ( 16 ). In dental education, smart glasses contribute to improved clinical care by emphasising both distance learning and clinical practice. Integration of smart glasses in dentistry offers several advantages. They significantly enhance the dentists’ workflow by enabling hands-free access to core knowledge, optimizing the clinical processes, and saving time. In dental education, smart glasses provide significant benefits by capturing the clinical procedures from the practitioner’s point of view and offering valuable learning experience for students ( 15 ). Most existing research focuses on the preclinical training period while studies evaluating clinical training environments remain insufficient. This inadequacy prevents a full understanding of the potential of video-supported methods during the critical internship period, in which dental students develop their clinical skills on real patients. Therefore, this study aimed to investigate the effects of three different methods used in dental clinical internship training [traditional internship observation, live video monitoring of the surgical procedure via a monitor in the classroom, and a hybrid educational method (the combination of traditional observation and live video monitoring of the surgical procedure)] on students’ knowledge level, clinical awareness, observation skills, and overall learning experience. It is anticipated that the data obtained from this study will contribute to the development of student-centered, multi-observer–based teaching approaches in clinical surgical education, the standardization of hybrid educational models, and the establishment of a scientific basis for future clinical training protocols. The hypotheses were tested in this study: [1] different educational methods will have differential effects on students’ knowledge levels; [2] the hybrid observation method will enhance students’ abilities to observe the surgical process, follow technical steps, and develop clinical awareness more effectively than the other methods; and [3] the hybrid observation method will yield the highest outcomes in terms of students’ learning attitudes, motivation, and perceptions of professional development. METHODS Ethical Approval and Study Design This study received ethical approval from the Non-Interventional Clinical Research Ethics Committee of Uşak University Faculty of Medicine, (decision no. 28), issued at its meeting on September 11, 2025. This study adopted a sequential explanatory mixed-methods design, in which quantitative data were collected and analyzed first, followed by qualitative analysis to further explain and interpret the quantitative results (17). Sample Size The sample size of the study was calculated using G*Power 3.1.9.7 software. Similar studies in the literature comparing the effectiveness of educational interventions have reported that a effects size value of 0.50 is considered a “large effect size” and is commonly used as a reference for sample size calculations using G*Power (1, 18). This support from the literature strengthens the validity of the chosen effect size assumption. The significance level (α) was set at 0.05, and the statistical power (1−β) was set at 0.80. According to analysis conducted for three groups, the required total sample size was calculated as 42. This method was preferred to ensure that the study achieves adequate statistical power and is conducted with an ethically appropriate number of participants. Participants Students at Uşak University Faculty of Dentistry begin their Oral and Maxillofacial Surgery internship from the third year onward. This internship includes clinical and theoretical practices. Clinical practices become more intensive from the fourth year onward. They gain clinical and theoretical knowledge about advanced surgical procedures. This study included 94 students, with an average age of 23.1 ± 0.9, who were 5th-year students at Uşak University Faculty of Dentistry, completed their Oral, Dental and Maxillofacial Surgery internship observation based on implant surgery during the specified study period and fully completed the questionnaire. Inclusion criteria for the study are as follows: The 5th-year students of Uşak University Faculty of Dentistry must have completed their Oral and Maxillofacial Surgery internship during the study period. Exclusion criteria for the study are as follows: - Students refusing to participate in the study - Operations of patients who did not give informed consent for video recording and live video streaming of the operation could not be used as a data source for the video-assisted groups of the study. - Students who had previously observed implant surgery prior to the study period - Students who were absent on the day of the operation observation. Randomization and Grouping Fifth-year students of Uşak University Faculty of Dentistry were divided into three groups using simple random sampling method, with a minimum of 29 students in each group. Randomisation was performed using the online random number generator at www.randomizer.org to prevent potential bias in group assignments. According to the resulting list, the students were assigned to “Traditional Observation”, “Live Video Streaming” and “Hybrid Observation” groups, respectively. Randomization process was conducted by a neutral researcher who was not involved in the data collection process. Group allocation was concealed until the observation day, and students were not informed about alternative observation methods to minimize performance bias. Representative sample of images of the study groups are presented in Figure 1. The definitions of the study groups are as follows. Traditional Observation Group (Group 1): The students observed the surgical procedures in the operating room in person, and followed the process under the guidance of a lecturer. No video recording or live video streaming support was provided during the surgical procedures. This method represents a traditional operating room-based observation widely used in dental clinical education. Live Video Streaming Group (Group 2): Students in this group followed the surgical procedures via live video streaming on a monitor located in the classroom, separate from the operating room. Students do not have physical access to the operating room. Hybrid Observation Group (Group 3): Students in this group followed the surgical procedures both through traditional in-person observation and live video streaming on a monitor located in the operating room. Video Recording and Live Streaming System The video recordings used in the study were obtained using Ray-Ban Meta Wayfarer smart glasses (Ray-Ban, EssilorLuxottica, Milan, Italy). Ray-Ban Meta smart glasses were preferred due to their lightweight design, first-person perspective camera alignment, suitability for use in sterile environments and real-time wireless transmission capability without the need for additional equipment. These smart glasses feature a 3024 x 4032 pixel camera resolution, a 4-hour charging time, dual speakers, 5 microphones (Figure 2). They can be controlled via touch or voice and feature Wi-Fi-based live video streaming capabilities. Images were recorded from the first-person (trainer) surgical specialist's perspective, and the camera was positioned within the surgeon's natural line of sight to ensure a clear view of the patient's oral tissues. Live video streaming was carried out through a closed broadcasting system accessible only to the observation groups. For this purpose, a private, password-protected account was created on the Instagram platform and throughout the study. The account was managed exclusively by the research team, with access restricted to relevant student groups for a limited time. Data privacy was maintained throughout the broadcast, and patients’ facial areas and identifying information were not visible at any stage. The footage obtained during the broadcast was not downloaded, archived or shared with third parties; they were used solely for simultaneous educational purposes. Following completion of the study, the account was permanently deactivated, and no digital broadcast content was stored. Live video streaming and video display were conducted using ASUS-brand LED (Light Emitting Diode) monitors with a 2560 × 1600 Retina resolution. Depending on the study group, monitors were placed in the operating room or in the Faculty of Dentistry student study room. During transmission, video quality, colour contrast, and synchronization were monitored by a member of the research team and no technical malfunctions were observed. This equipment and transmission system were selected to enhance the quality of educational observation of surgical procedures and enable students to evaluate the procedures from multiple perspectives. (Figure 3). Data Collection Tools and Procedure This study was conducted among undergraduate students studying at Uşak University Faculty of Dentistry who participated in the Oral and Maxillofacial Surgery observation internship during the 2025–2026 academic year. Data were collected using anonymous survey forms on a voluntary basis. The study was conducted in accordance with the relevant ethical principles and regulations set forth in the Declaration of Helsinki. The surgical procedures performed in the posterior jaw region (molar implant surgery) were evaluated within the scope of the research. Implant surgeries performed in the molar region were included in this study because access to this area is difficult and the field of vision is limited, which can negatively affect students’ visual learning experience. However, the aim was to ensure that the training provided was of equal standards by conducting the study in similar regions. The study included patients who provided written informed consent for video recording during the operation and its use for educational purposes. Patients who did not consent to video recording during the procedure or did not provide written informed consent were excluded from the study. All surgical procedures were carried out by a surgical specialist in accordance with faculty standard protocols. The patients were informed that participation in the study was voluntary and that video recording would not affect the operation or the duration of it. In addition, students were informed that completion the questionnaire was voluntary and that their responses would not affect their academic status or individual performance. This study employed a mixed-methods design, integrating quantitative performance outcomes with qualitative interview data to provide a comprehensive evaluation of the educational intervention. In this study, a custom designed survey form was used to collect both quantitative and qualitative data. Questionnaire form was refined by the study team and a statistical consultant after reviewing comparable studies in literature. The draft of the questionnaire was submitted for expert review to assess its alignment with the study objectives, scope, clarity of statements, and content validity and was finalized following the necessary revisions based on the feedback received. The first section of the questionnaire (Appendix-1), consists of four questions related to the surgical area, the procedure performed, the anesthesia method used, and the radiological evaluation, designed to measure students' knowledge and awareness of the procedure during observation. The quality of observation and its educational contribution were assessed using thirteen items of the second section of the questionnaire. The third section of the questionnaire consists of an open-ended question that allows participants to evaluate their general views and experiences regarding the observation method in detail. The final section of the questionnaire asked students to provide qualitative comments on the study. The reliability of the questionnaire was assessed through a pilot study conducted with 30 students (19) and Cronbach's alpha coefficient was calculated as 0.953, which indicates excellent reliability. The content validity of the questionnaire was reviewed by experts in oral and maxillofacial surgery education and biostatistics and was considered appropriate for the objectives of this study. Statistical Analysis The process of analyzing quantitative data Data analysis was performed using SPSS software (Version 27.0; IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize the demographic characteristics of the participants and their responses to the questionnaire, presented as frequencies (n) and percentages (%). To evaluate the differences in categorical variables and student perceptions across the study groups, Fisher’s Exact test was utilized. This test was preferred due to the expected cell counts in the contingency tables being less than five, ensuring a more accurate analysis of the small sample size distributions. A p-value of less than 0.05 was considered statistically significant for all tests. The process of analyzing qualitative data In this study, the Standards for Reporting Qualitative Research (SRQR, Appendix-2) were followed to enhance the methodological rigor, transparency, and credibility of the qualitative results ADDIN EN.CITE O’Brien2014299(20, 21)29929917O’Brien, Bridget CHarris, Ilene BBeckman, Thomas JReed, Darcy ACook, David AStandards for reporting qualitative research: a synthesis of recommendationsAcademic medicineAcademic medicine1245-125189920141040-2446Majid201830030030017Majid, UmairVanstone, MeredithAppraising qualitative research for evidence syntheses: a compendium of quality appraisal toolsQualitative health researchQualitative health research2115-2131281320181049-7323 (20, 21) , enabling readers to apply or transfer the results to their own situations, contexts, time, and populations (22, 23). This study was conducted using a phenomenological qualitative research design in order to explore dental students’ perceptions and learning experiences related to surgical observation in depth. Phenomenology is an approach that aims to elucidate individuals' experiences, perceptions, and the meanings they attribute to a particular phenomenon (24). For this reason, it was chosen as an appropriate method to understand students' experiences with different surgical observation methods. The study sample consisted of students who participated in implant surgery trainings held at a faculty of dentistry and experienced three different surgical observation methods. In the qualitative data collection process, a purposive sampling strategy was used to reveal how students' perceptions of their viewing experiences were shaped within the context of different levels of knowledge. Criterion sampling, a type of purposive sampling methods was used. The criteria included participation in the relevant surgical observation and voluntary provision of feedback regarding the experience. Within this context, based on the responses to the knowledge assessment questions administered prior to the surgical observation process, students with the highest and lowest levels of knowledge were identified in each observation group. From among these selected students, participants were included in the interviews in a manner that represented approximately two-thirds of each group. The aim is to represent the diversity of experiences within the group while maintaining qualitative data depth and ensuring data saturation. Thus, the aim was for the qualitative data to reflect not only average experiences but also experiential diversity and extremes. In total, three groups were evaluated according to the surgical observation methods. In-depth interviews, one of the fundamental methods of qualitative research, are most frequently used in healthcare settings and represent one of the most established qualitative data collection methods. Such in-depth interviews are typically semi-structured, based on a small number of preplanned open-ended questions, and follow a progression-based line of inquiry. The strength of in-depth interviews lies in their ability to analyze the research topic in depth and in detail from participants' perspectives (25). The data were collected through a semi-structured interview form developed by researchers. In-depth interview questions were designed in a non-directive and open-ended manner to enable students to comparatively evaluate their experiences with different observation methods. The same questions were asked of all participants, and were asked to respond based on their own experiences with the observation method they had undergone. In-depth interview questions were designed to cover the level of visibility of the surgical field, learning experiences, perceived educational contribution, and advantages/disadvantages of the observation method. In-depth interviews were conducted after obtaining participants' written informed consent, and were audio recorded. Questions -How would you generally describe the surgical observation method you experienced? What were the most important aspects of this experience for you in terms of its contributions to your learning and professional development? -How did your level of visibility of the surgical field affect your ability to understand and follow the surgical procedure? -During this observation process, which aspects do you think you gained the most insight into? (e.g., use of surgical instruments, doctor–patient communication, ergonomics) -What are the strengths and limitations of the observation method you experienced? -Is there anything else you'd like to add regarding your experience observing the surgery? At the end of the in-depth interviews, participants were asked whether they had any additional comments. During the in-depth interviews, the concept of data saturation, which is commonly used in qualitative research on oral health (26, 27) and has been extensively studied in the research community (28), was applied. Participants were asked to reflect on their answers during the interviews until data saturation was achieved or no new information was obtained. The data collection process was terminated when new themes or concepts began to recur during the interviews, and additional interviews failed to make a meaningful contribution to the existing themes. This approach ensured that each group adequately reflected the diversity of experiences within the group. Interviews lasted an average of 30 minutes. All audio recordings were transcribed word for word after the interviews and prepared for qualitative analysis. The data obtained were analyzed using the content analysis method. The analysis process began with researchers becoming familiar with the data by repeatedly reading all interview transcripts. Following this stage, meaningful statement units relevant to the research purpose were identified from the participants' statements and these units were coded. The coding and theme creation processes were carried out using MAXQDA Analytics Pro (version 24.4.1) software to ensure the systematic organization of the data. MAXQDA software was chosen because it allows for the systematic coding of qualitative data, visual and analytical comparison of themes, and transparent monitoring of the analysis process. The analysis process was conducted using an inductive approach, with themes derived directly from participant statements without relying on a predetermined framework. Frequency values were used to more transparently reveal the dominance and distribution of the themes. However, these frequencies are not intended for quantitative generalization; they only aim to show the relative importance of themes and their level of visibility within the data. This approach is consistent with the descriptive quantification framework recommended in qualitative research. The coding process was conducted independently by two researchers in order to enhance the reliability of the qualitative analysis process. Researchers independently reviewed the interview transcripts, identified meaningful units of meaning, and generated preliminary codes. Following the independent coding process, the codes were compared, and areas of disagreement were discussed and resolved. Inter-coder agreement was assessed using Cohen's kappa coefficient, with a kappa value (κ = 0.79) indicating good agreement. The interviews were conducted by researchers experienced in oral and maxillofacial surgery education who were not involved in the academic assessment of the participating students. To minimize potential researcher bias, a neutral and non-directive interview approach was adopted during data collection. Reflexive discussions were conducted throughout the coding and analysis process, and independent coding by two researchers followed by consensus meetings helped reduce subjective interpretation and enhance analytic rigor. In order to ensure the rigor of qualitative research, the principles of credibility, dependability and confirmability suggested by Lincoln and Guba (29) were taken into consideration. The methodological rigor of the study was addressed in accordance with the reliability criteria suggested in qualitative research. Transferability was strengthened by detailed reporting of the research context, sample characteristics, and data collection process. Dependability and confirmability were supported by systematically conducting the analysis process, clearly defining the coding steps, and reaching a consensus among researchers (30). This process is consistent with current literature recommendations for increasing methodological rigor in qualitative research (24, 31). Quantitative Results A total of 94 fifth-year dental students participated in the study. The participants were distributed into three groups: traditional observation (n=35), live-streaming (n=30), and hybrid observation (n=29). No statistically significant differences were observed between the groups regarding age, gender distribution, or prior clinical observation experience (p > 0.05), indicating a homogeneous distribution across the study (Table 1). Analysis of participants’ responses to the four knowledge-based questions revealed a statistically significant difference between the groups only for the question on preoperative radiological evaluation (p = 0.009). For this item, the correct response rate among students in Group 3 (38.7%) was significantly higher than that of the other groups (Table 1). No statistically significant differences were observed between the groups for the remaining three questions (surgical area, type of surgical procedure, and anesthesia method) (p > 0.05). Table 1. Comparison of correct answer rates for knowledge level questions Question Subject Significance (p*) The group that showed the highest accuracy rate 1 Operation field 0.329 - 2 Type of surgical procedure 0.329 - 3 Anesthesia method 0.343 - 4 Radiological evaluation 0.009 Group 3 Fisher’s Exact Test; p < 0.05 was considered statistically significant. According to Fisher’s exact test results, statistically significant differences were found in various items between observation environment and students’ attitudes (p <0.001). Specifically, the students observing in Group 3 reported the highest rates of positive responses for most attitude items (Table 2). The students in the hybrid observation group reported the highest rates of positive responses for items such as The ability to follow the sequence of surgical instrument use (Question 6) (93%), The ability to observe the surgeon's interaction with the patient (Question 9) (100%), Complication management, Decision-making under stress, and The observation of patient behaviours (Questions 16 and 17), with all p-values < 0.001. Furthermore, the hybrid observation method was found to be significantly more effective than traditional and live video methods in terms of The educational value of the surgeon’s explanations (Question 12) (97%), Connecting theoretical knowledge with practice (Question 13) (97%), and Contribution to professional development (Question 15) (97%) (p < 0.001; Table 2). Table 2. Comparison of attitude scores according to observation environment Question No. Survey Item (Abbreviated) Group 1 (%) Group 2 (%) Group 3 (%) p* 6 The ability to follow the sequence of surgical instrument use 39.9 80.0 93.0 <0.001 9 Ability to observe patient communication 80.0 93.0 100.0 <0.001 12 The educational value of the surgeon’s explanations 48.9 85.9 97.0 <0.001 13 Connecting theoretical knowledge with practice 20.0 82.9 97.0 <0.001 15 Contribution to professional development 31.0 94.0 97.0 <0.001 16 Decision-making under stress 40.0 90.0 94.0 <0.001 17 The observation of patient behaviours 59.7 93.0 94.0 <0.001 *Fisher’s Exact Test; p < 0.05 was considered statistically significant. Qualitative Results In this study, dental students’ perceptions of their surgical observation were analyzed using content analysis, and three main themes along with sub-codes associated with these themes were identified. The themes were analyzed comparatively according to surgical observation methods [group 1, group 2 and group 3]. Table 3 presents the main themes, associated sub-codes, and their frequency distributions, with each theme supported by direct student quotations. Table 3. Themes, codes, and frequencies related to students' experiences observing surgery Theme Code Group 1 (n) Group 2 (n) Group 3 (n) Theme 1: Visual access and clarity of the surgical field Limited field of view 28 6 4 Inability to see details 25 7 5 Increased clarity with monitor/camera 3 21 34 Theme 2: Learning experience and educational contribution Educational and productive experience 19 24 37 Reinforcement of theoretical knowledge 14 22 29 Ability to follow the steps of the process 12 20 33 Theme 3: Clinical Setting and Professional Awareness Surgeon and patient communication 26 9 31 Surgeon positioning and instrument use 23 8 28 The professional contribution of the clinical atmosphere 21 7 30 Frequencies (n) represent the number of times the relevant code was mentioned at least once in participant statements and are not intended for quantitative generalization; they are presented to reflect the relative dominance of the themes. Theme 1: Visual access and clarity of the surgical field This theme encompasses the experiences of students related to their ability to view the surgical field. It was observed that visual access had a significant effect on learning experience, depending on the observation method. Group 1: It was frequently stated that the field of view was inadequate and that the intraoral area could not be clearly visualized. I could not see the inside of the mouth, and had difficulty understanding the procedures because we observed them remotely. (Student 17) Group 2: Although it was emphasized that the surgical field was clearly visible, occasional technical issues were reported. “Seeing the procedure from the surgeon’s perspective was very beneficial; although there were occasional freezes, I was able to clearly follow the procedures.” (Student 52) Group 3: The use of monitor support was emphasized as significantly enhancing visual access. “We were able to clearly observe areas that we could not see directly, which made it easier for me to understand the procedures.” (Student 81) Theme 2: Learning experience and educational contribution This theme encompasses how students evaluate surgical observation in terms of the learning process. The learning experience was examined through students’ ability to understand procedural steps, connect theoretical knowledge with practice, and their perceptions of professional development. Group 1: Despite the limited visual resources, it was noted that the instructor's explanation facilitated learning. “Even though I couldn't see the details, the process was educational thanks to what our instructor explained.” (Student 9) Group 2: Provided positive feedback regarding the application of theoretical knowledge to practice. “Seeing implantology, which we learned in theory, put into practice was very beneficial for me.” (Student 43) Group 3: The learning experience was observed to occur most frequently. “Watching it live and seeing the details on the screen helped me understand the surgery much better.” (Student 68) Theme 3: Clinical Setting and Professional Awareness This theme encompasses students’ presence in clinical setting and their observations of dentist-patient-assistant interaction. Group 1: Although students were unable to observe the surgical field, they stated that experiencing the clinical setting was professionally valuable. “I could not see the inside of the patient’s mouth but observing the communication between the instructor and the patient, as well as the use of instruments, was highly beneficial.” (Student 3) Group 2: This theme was expressed to a more limited extent in the live video streaming group. “It was beneficial to watch the procedure live but experiencing the atmosphere of the operating room would have been different. ” (Student 58) Group 3: When clinical setting experience was combined with visual support, a high level of learning was reported. “Being physically present in the clinical setting and viewing the details on the screen increased my professional awareness.” (Student 74) Overall, the qualitative findings revealed that different methods of observing surgical procedures affect the students’ learning experiences through different mechanisms. While observing from operating room contributed to experiencing the clinical atmosphere and observing professional interactions, it remained limited in terms of visual access. The live video streaming method enhanced visual clarity, however it partially limited the clinical setting experience. In contrast, the monitor supported observation method in operating room emerged as the most comprehensive learning experience by offering visual access, learning effectiveness and clinical awareness together. When these themes are considered together, it becomes evident that the methods of observing the surgical procedures shape students’ learning experiences not only at the level of information transfer; but also through interrelated mechanisms such as visual access, cognitive processing and clinical contextual awareness. DISCUSSION This study is one of the few studies evaluating the effectiveness of a live video supported hybrid observation method in dental clinical education. The findings of the study show that the hybrid observation method provides a significant advantage in enhancing students’ knowledge level and improving their understanding of the critical stages of the surgical process. In line with the first hypothesis the findings indicate that educational methods have different effects on students’ knowledge level; especially the hybrid observation method was found to be more successful than the other methods in accurately identifying pre-procedural radiological evaluation. Although four knowledge-based questions were included in the questionnaire, statistically significant differences between the observation groups were observed only for the item related to preoperative radiological evaluation. The absence of significant differences in the remaining knowledge questions (surgical area, type of procedure, and anesthesia method) may be explained by the relatively basic nature of these items and the comparable baseline theoretical knowledge levels of fifth-year dental students who had already completed the relevant coursework. These findings suggest that observation methods may have a stronger impact on interpretative clinical awareness than on basic factual knowledge acquisition. In line with the second hypothesis, the hybrid observation method significantly enhanced students’ ability to observe the surgical procedures, follow the technical stages, and develop clinical awareness. In line with the third hypothesis the hybrid observation method was expected to have the greatest impact on students’ learning attitudes, motivation and perceptions of professional development, and the findings have strongly supported this hypothesis. For this reason, all the hypotheses tested in this study are supported by the findings and were accepted. Significant differences were observed among the three methods in terms of students’ knowledge levels, ability to observe surgical procedures, and learning attitudes, with the hybrid observation method found to be the most effective. Smart glasses have the potential to enhance dental education, teaching, and clinical practice, serving as an innovative alternative both the educational and practical aspects of dentistry ( 32 ). A previous study reported that smart glasses may improve medical students’ acquisition of various surgical skills in surgical education ( 33 ). The Ray-Ban Meta smart glasses used in this study provided high resolution, providing real-time image transmission from the surgeon's first-person perspective, allowing students to observe the surgical process directly from the practitioner's viewpoint. The integration of the camera with the natural head position provided a high level of alignment between trainer’s field of view and the images observed by students on the monitors; thus the limitations frequently reported in traditional observation such as loss of viewing angle, crowding and physical positioning constraints were largely reduced. The live streaming capability supported real-time learning and offered a pedagogical advantage particularly in facilitating the understanding of the complex surgical steps. Accordingly, in clinical settings where physical space and viewing limitations are prominent, smart glasses supported hybrid observation methods may be considered a strong and applicable alternative for enhancing the quality of learning. This study showed that the hybrid observation methods had a significant impact on students’ observational skills and learning process in cases where physical limitations of the operating room restricted students' learning experience. This finding supports the notion that technological integration may enhance the quality of learning, as also indicated in a systematic review related to digital dental education ( 3 ). The findings of the study demonstrate that the hybrid observation method provides a significant advantage in enhancing students’ knowledge levels and understanding the critical steps of the surgical procedure. Particularly in the question regarding radiological evaluation before the procedure, the higher rate of correct responses among students in the hybrid observation group compared with the other groups indicates that the visual continuity provided through the monitor supports the acquisition of knowledge. This finding is consistent with a study evaluating the effectiveness of different video types online learning, which reported that observation based videos more strongly support conceptual learning ( 4 ). In this study, live streaming support enabled students to more clearly observe the scope of surgical procedure, the instruments used and the surgeon’s decision making process. Similarly, Qutieshat et al. ( 14 ) reported that blended learning enhances dental students’ clinical performance and satisfaction levels. This learning process, supported by both visual and auditory inputs, suggests that hybrid observation method contributes to cognitive learning as well as affective learning. In this study, the findings related to attitude questions also indicate that the hybrid observation method offers advantages in terms of the learning experience. Students rated the hybrid observation method significantly higher than other observation methods in terms of instructiveness of the surgeon’s explanations, linking the theoretical knowledge with practice, and contribution of professional development. This finding is consistent with literature indicating that video supported observation enhances students’ cognitive engagement and sustained attention ( 8 ). A study reported that video supported hybrid observation methods in veterinary surgical education strengthen the clinical awareness of students ( 34 ). Similarly, consistent with our findings, Al-Elq et al.( 35 ) reported that hybrid video approaches in medical education enhance students’ practical learning skills. In addition, our study also revealed the main difference between video-based observation method alone and hybrid observation method. Although students in live streaming group followed the overall flow of the surgical procedure, students in the hybrid observation group reported higher satisfaction with reviewing the visual and contextual aspects of the procedure. The opportunity to directly observe the surgeon’s communication, patients’ reactions and complication management enabled students to develop a more holistic perspective on the clinical process. This finding supports the studies emphasizing that active observation and multisensory learning play an important role in clinical skills development ( 9 , 36 ). This finding particularly suggests that the hybrid observation method is the approach that most effectively facilitates students' understanding of material and their ability to relate it to processes. Although traditional observation and live streaming methods contribute to students’ learning processes, the hybrid observation method received higher ratings in terms of clearly observing the surgical field, better understanding of procedural steps, and increasing clinical awareness. A previous study reported that the model that includes live demonstrations and formative assessment improved students’ orthodontics skills ( 37 ). Similarly, another study reported that the flipped classroom approach combined with case based learning improved students’ clinical decision-making and analytical thinking skills ( 38 ). These findings support that the hybrid observation method is a model that promotes active participation in clinical learning and strengthens practice skills. While Ramlogan et al. ( 5 ) reported that video demonstrations in periodontology education did not significantly contribute to the students’ tests results, our study showed that the hybrid observation method resulted in significant differences in both knowledge and attitude levels. This difference may be attributed to the method used in our study, which integrates the live transmission and observation in the operating room. The opportunity to observe surgical procedures simultaneously, from the surgeon’s perspective enabled students to shift from a passive viewer to an active observer. However, the findings of this study support the applicability of the hybrid observation method in dental education. Previous studies have also reported that video based and hybrid education practices support both cognitive and behavioral learning processes ( 8 , 39 ). Particularly, in surgical disciplines, when students cannot directly participate in observation due to limited physical space or infection control protocols, the hybrid observation method can ensure educational equality while preserving quality of education. In addition, the hybrid observation method can be easily implemented with low-cost hardware (e.g., Ray-Ban Meta Wayfarer smart glasses), which may offer a practical solution for dental faculties. Qualitative findings suggest that the learning outcomes of surgical operation observation cannot be reduced to a single factor; on the contrary they are shaped by the simultaneous interaction of visual access, cognitive integration, and clinical contextual experience. Within this context, the identified themes should be considered not merely as descriptive categories but also as functional components that structure students’ surgical learning experience. This study offers a holistic model of learning mechanisms in surgical education by revealing the levels at which this different surgical observation methods activate these components. According to the qualitative findings of this study, the process of operating room observation enables students to experience the clinical environment and understand surgeon-patient- assistant interactions, thereby supporting professional socialization and contextual learning. However, limited visual access restricted the cognitive processing. Live interaction demonstrations of clinical procedures have traditionally been quite effective in dental education. However, the integration of demonstrations has increasingly been adopted to improve teaching methods ( 10 ). Observation via live video streaming facilitated the understanding of procedural steps by enhancing the clarity of the surgical field; however it weakened the contextual dimension of learning due to limited exposure to the physical and emotional component of the clinical environment. The limited effectiveness of using video demonstrations alone in the teaching of clinical skills, may stem from reduced student interaction and participation in this mode. Interaction and participation are crucial for enhancing student’s understandings and increasing their self-confidence ( 10 ). To mitigate this limitation, the hybrid observation method strengthens students’ both cognitive and contextual learning processes by integrating visual access with clinical environment experience. In addition, students reported that the hybrid observation method provided significant advantages, particularly by enhancing the visual access, facilitating understanding of procedural steps, and maintaining attention during the lesson. Furthermore, it was observed that the hybrid observation method increased the students’ motivation, helped them find surgeon’s explanations more instructive, and contributed to their understanding of the clinical process as a whole. These results indicate that the hybrid observation model is the most effective method for enhancing both cognitive learning and the quality of clinical observation. Overall, the hybrid educational method was evaluated by students as the most instructive and effective observation setting. Students’ reporting of technical issues at minimal levels, together with high overall satisfaction, strengthens the feasibility and acceptability of the hybrid observation method. Similar to previous study, the current study also demonstrated satisfaction with the use of videos used in dental educatio ( 40 ). Consistent with findings in the literature indicating that video-supported and hybrid models increase student motivation, focus, and clinical awareness ( 37 , 41 ), the results of this study suggest that the hybrid approach contributes not only to cognitive learning but also to affective and behavioral learning processes. The combination of quantitative and qualitative findings indicated that improved visual access (quantitative results) was supported by students’ perceptions of increased clarity and a better learning experience (qualitative findings), thereby reinforcing the overall interpretation of the mixed-methods model. This study has some limitations. The research was conducted at a single center, and students’ learning experiences were evaluated over a short period. Students’ long term clinical learning outcomes, knowledge levels, and their effects on real patient practices were not evaluated. Only a specific surgical procedure was used in this study, which limits inferences regarding different levels of surgical difficulty. Some opinions may not be represented as qualitative data collection is based on voluntary participation. In addition, differences in equipment and technical infrastructure may affect the application when transferring the technology based hybrid observation method to other institutions. This study focused on students’ learning experience. Future research is recommended to include multicenter designs, different surgical topics, long period follow-up, and objective performance metrics. CONCLUSION This study shows that the hybrid observation model (both direct observation and live streaming) contributes positively to dental students’ surgical education and that this method can serve as a strong complement to traditional education models. It reveals that surgical dental education can be accessible even under limited physical conditions and can be carried out effectively. The hybrid observation model provided students with a more holistic and instructive learning experience by combining the advantages of direct observation of the surgical field with the expanded viewing angle offered by live streaming transmission. First-person smart glasses videos have positively affected learning and the student experience in oral and maxillofacial surgery training by enhancing the perceptibility of surgical procedures. Future studies with expanded samples are recommended to more comprehensively evaluate the effects of hybrid education on long-term skill acquisition. Abbreviations SD Standard deviation SPSS Statistical Package for the Social Sciences SRQR Standards for Reporting Qualitative Research Declarations Human Ethics and Consent to Participate This study received ethical approval from the Non-Interventional Clinical Research Ethics Committee of Uşak University Faculty of Medicine, (decision no. 28), issued at its meeting on September 11, 2025. Written informed consent was obtained from all participants prior to participation in the study. Clinical Trial Number Not applicable Consent for Publication Not applicable. Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no external funding. Authors’ Contributions Muhammed Fatih Çiçek and Muhammet Fidan designed the study. Muhammed Fatih Çiçek and Muhammet Fidan conducted the methodology. Ahmet Caymaz, Muhammet Demirkaya, Muhammed Mustafa Sağer, Alperen Şamil Karabek, Defne Dayan and Çağla Saygın collected the data. Muhammed Fatih Çiçek and Muhammet Fidan analyzed the data. Muhammed Fatih Çiçek drafted the manuscript. All authors reviewed and approved the final manuscript. Acknowledgements Not applicable. References Shqaidef AJ, Abu-Baker D, Al-Bitar ZB, Badran S, Hamdan AM. Academic performance of dental students: a randomised trial comparing live, audio recorded and video recorded lectures. Eur J Dent Educ . 2021;25(2):377-84. Maggio MP, Hariton-Gross K, Gluch J. The use of independent, interactive media for education in dental morphology. J Dent Educ . 2012;76(11):1497-511. Zitzmann NU, Matthisson L, Ohla H, Joda T. Digital undergraduate education in dentistry: a systematic review. Int J Environ Res Public Health . 2020;17(9):3269. Fidan M, Debbağ M. Comparing the effectiveness of instructional video types: an in-depth analysis on pre-service teachers for online learning. Int J Hum-Comput Interact . 2023;39(3):575-86. Ramlogan S, Raman V, Sweet J. A comparison of two forms of teaching instruction: video vs live lecture for education in clinical periodontology. Eur J Dent Educ . 2014;18(1):31-8. Fakhry A, Cooper S, Slach N, Krenz S. Video-assisted clinical instruction in dentistry: overview and applications. Eur J Dent Educ . 2007;11(4):230-7. Messer LB, Kan K, Cameron A, Robinson R. Teaching paediatric dentistry by multimedia: a three-year report. Eur J Dent Educ . 2002;6(3):128-38. Fidan M, Fidan M. The effects of video-driven discussions integrated into the flipped classroom model on learning achievement, practical performance, and higher-order thinking skills in dental education. J Comput Assist Learn . 2024;40(1):158-75. Packer ME, Rogers JO, Coward TJ, Newman PS, Wakeley R. A comparison between videotaped and live demonstrations for the teaching of removable partial denture procedures. Eur J Dent Educ . 2001;5(1):17-22. AlKahtani RN, Alnufaiy BM, Albaijan RS, Alnafaiy SM, Elfakhri FM, Aljudaibi SM. Comparing the efficacy of live vs video instructional demonstrations in dental education: a systematic review and meta-analysis. BMC Med Educ . 2025;25(1):108. Gross RT, Ghaltakhchyan N, Nanney EM, Jackson TH, Wiesen CA, Mihas P, et al. Evaluating video-based lectures on YouTube for dental education. Orthod Craniofac Res . 2023;26(Suppl 1):210-20. Paegle RD, Wilkinson EJ, Donnelly MB. Videotaped vs traditional lectures for medical students. Med Educ . 1980;14(6):387-93. Brockfeld T, Müller B, de Laffolie J. Video versus live lecture courses: a comparative evaluation of lecture types and results. Med Educ Online . 2018;23:1555434. Qutieshat AS, Abusamak MO, Maragha TN. Impact of blended learning on dental students’ performance and satisfaction in clinical education. J Dent Educ . 2020;84(2):135-42. Iqbal MZ, Campbell AG. Adopting smart glasses responsibly: potential benefits, ethical, and privacy concerns with Ray-Ban stories. AI Ethics . 2023;3(1):325-7. Xiao Y, Lian G, Zhang J, Chen Q, Wang H, Huang L, et al. Efficacy of a smart glass-enhanced training programme for core doctor-patient communication skills among radiology residents in China. Eur Radiol Exp . 2025;9(1):92. Creswell JW. Research design: qualitative, quantitative and mixed methods approaches . 3rd ed. Thousand Oaks (CA): Sage; 2003. Al-Zain AO, Abdel-Azim AM, Othman HI. Dental students’ didactic and psychomotor skills performance in dental anatomy and preclinical operative dentistry courses in a Saudi governmental school. Int J Dent . 2021;2021:7713058. Bujang MA, Omar ED, Foo DHP, Hon YK. Sample size determination for conducting a pilot study to assess reliability of a questionnaire. Restor Dent Endod . 2024;49(1):e3. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med . 2014;89(9):1245-51. Majid U, Vanstone M. Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools. Qual Health Res . 2018;28(13):2115-31. Dashash M, Alkhadragy R, Scanlan GM. A phenomenological exploration of experience of Syrian dentists with online course “traumatic dental injuries”. Heliyon . 2024;10(13):e34045. Connelly LM. Trustworthiness in qualitative research. Medsurg Nurs . 2016;25(6):435-6. Sundler AJ, Lindberg E, Nilsson C, Palmér L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open . 2019;6(3):733-9. Chai HH, Gao SS, Chen KJ, Duangthip D, Lo ECM, Chu CH. A concise review on qualitative research in dentistry. Int J Environ Res Public Health . 2021;18(3):942. Shubayr MA, Kruger E, Tennant M. Oral health providers’ views of oral health promotion in Jazan, Saudi Arabia: a qualitative study. BMC Health Serv Res . 2023;23(1):214. Finlayson TL, Cabudol MJ, Liu JX, Garza JR, Gansky SA, Ramos-Gomez F. A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program. BMC Oral Health . 2019;19(1):166. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant . 2018;52(4):1893-1907. Lincoln YS, Guba EG. Naturalistic Inquiry. Thousand Oaks (CA): Sage; 1985. Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Health . 2024;2:100051. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods . 2017;16(1):1609406917733847. Ahmed WM, Azhari AA. Smart glasses in dentistry: technologies, use cases, and future directions. Biomed Eng Comput Biol . 2025;16:11795972251404258. Sato T, Sandars J, Brown J, Rogers SN. Usefulness of smart glasses and point of view for suturing skills training in medical students: pilot study. BMJ Simul Technol Enhanc Learn . 2020;7(3):173-5. Müller LR, Tipold A, Ehlers JP, Schaper E. TiHoVideos: veterinary students’ utilization of instructional videos on clinical skills. BMC Vet Res . 2019;15(1):326. Al-Elq AH. Simulation-based medical teaching and learning. J Fam Community Med . 2010;17(1):35-40. Kneebone R. Simulation in surgical training: educational issues and practical implications. Med Educ . 2003;37(3):267-77. Sivarajan S, Soh EX, Zakaria NN, Kamarudin Y, Lau MN, Bahar AD, et al. The effect of live demonstration and flipped classroom with continuous formative assessment on dental students’ orthodontic wire-bending performance. BMC Med Educ . 2021;21(1):326. Yang F, Lin W, Wang Y. Flipped classroom combined with case-based learning is an effective teaching modality in nephrology clerkship. BMC Med Educ . 2021;21(1):276. Dervisbegovic S, Laky M, Tur D, Grundnig J, Rausch-Fan X, Moritz A, et al. Educational videos as a teaching approach to enhance dental students’ practical skills in preclinical courses. BMC Med Educ . 2025;25(1):1299. Abed H, Demyati A. Effectiveness of e-learning method on exodontia for dental students: a theoretical domain framework study. J Dent Educ . 2025;89(8):1257-66. Roshier AL, Foster N, Jones MA. Veterinary students’ usage and perception of video teaching resources. BMC Med Educ . 2011;11:1. Additional Declarations No competing interests reported. Supplementary Files Appendix1Questionnare.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 May, 2026 Reviews received at journal 15 May, 2026 Reviews received at journal 15 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviews received at journal 05 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers invited by journal 04 May, 2026 Editor invited by journal 25 Apr, 2026 Editor assigned by journal 22 Apr, 2026 Submission checks completed at journal 22 Apr, 2026 First submitted to journal 18 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9457604","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":638415188,"identity":"59ebb4a4-0187-4697-b74e-0562d67cf395","order_by":0,"name":"Muhammed Fatih 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18:53:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9457604/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9457604/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109204869,"identity":"f2b4d03d-0da1-4958-9a04-57a59e17be1f","added_by":"auto","created_at":"2026-05-13 15:02:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":993336,"visible":true,"origin":"","legend":"\u003cp\u003eObservation models used in the study:\u003cbr\u003e\n(A) Traditional observation group (Group 1), in which students observed the surgery inside the operating room;\u003cbr\u003e\n(B) Live video observation group (Group 2), in which students observed the surgery in real time via a live video feed;\u003cbr\u003e\n(C) Hybrid observation group (Group 3), in which students observed the surgery inside the operating room with simultaneous monitor support;\u003cbr\u003e\n(D) Monitor view used for live video–supported observation in the hybrid group\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9457604/v1/6fae8507f8dc9b86d6a16df9.png"},{"id":109101633,"identity":"63551bbf-beab-47b8-b916-060e1fb861e4","added_by":"auto","created_at":"2026-05-12 14:29:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":51434,"visible":true,"origin":"","legend":"\u003cp\u003eRay-Ban Meta Wayfarer smart glasses used for video recording\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9457604/v1/080716c6bb96f31b03182b6f.png"},{"id":109101822,"identity":"df4b55e3-9a83-4e56-9f30-b2f67b84cf54","added_by":"auto","created_at":"2026-05-12 14:29:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":462819,"visible":true,"origin":"","legend":"\u003cp\u003eMonitor view used for real-time video-supported observation during the surgical procedure.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9457604/v1/50aee3218315e9d88e8e066a.png"},{"id":109207275,"identity":"04327c21-a55c-4d59-909d-751ae684cecb","added_by":"auto","created_at":"2026-05-13 15:19:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2276181,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9457604/v1/baacc762-869d-4b21-b4ba-7bab287b6154.pdf"},{"id":109101789,"identity":"47b1f39e-cfe1-4f39-ae6e-c5a94b6ff81f","added_by":"auto","created_at":"2026-05-12 14:29:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":30068,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1Questionnare.docx","url":"https://assets-eu.researchsquare.com/files/rs-9457604/v1/47b4af682db15aebfe843134.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIntegrating First-Person Smart Glasses Video into Oral and Maxillofacial Surgery Education: A Mixed-Methods Study on Student Learning and Experience\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTraditional face-to-face lessons remain an indispensable component of dental education for knowledge transfer (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Along with rapid technological advancements digitally supported learning opportunities have improved. This situation has resulted in the integration of traditional learning models and digitally supported learning tools (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The digital tools which are integrated in emerging technologies in dental education enhance the capacity of teaching and have emerged as a promising alternative approach. Technological innovations in education and teaching, together with increased student access to electronic resources, have increased the importance of different teaching methods (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Especially voice and video records, virtual reality and methods such as haptic technologies have become an indispensable part of practical skill training in medical and dental education in recent years (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These developments facilitate the adoption of new approaches that support and enrich educational models.\u003c/p\u003e \u003cp\u003eIn practical dental education, video-based training aims to provide students\u0026rsquo; competencies in a standardized and efficient manner. This training method is used as an effective tool to improve and enhance the conventional education and to promote long-term retention (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Benefits of this training model are specified in terms of teaching practical competencies and their transfer to clinical practice (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Besides video recordings, live monitoring of intraoral procedures represents an additional approach. The effectiveness of the methods of live video instruction and video recording in teaching orthodontic emergency procedures to dental students were compared in a previous study. No statistically significant difference was observed between the two methods with respect to subject knowledge (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). One of the major limitations of live monitoring in clinical training is that intraoral procedures cannot be viewed by all students from the same perspective and with adequate clarity (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eReports addressing the effectiveness and perception of video lectures as a learning tool in health education are promising (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Studies have shown that medical students achieve similar test results following both live lectures and video-based instruction; while some students prefer live lectures, others favor video-based learning because it allows them to progress at their own pace and review the content as needed (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Existing studies also reveal certain challenges of video-based educational methods as perceived by students. Students may report being restricted to a single point of view, being unable to observe the working position of the dentist while performing the procedure, being unable to observe the reactions of the patient and experiencing distraction during video viewing. This issue results from passive observation of the educational material, highlighting the disadvantages of this non-interactive, one-way learning model (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). One of the most significant disadvantages of the traditional educational model is that, due to limited physical space, students are restricted to viewing intraoral procedures from the perspective of an experienced instructor (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This subject becomes more pronounced, particularly in operating room\u0026ndash;based procedures such as Oral and Maxillofacial Surgery and may prevent students from clearly observing the surgical field (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Therefore educators are seeking new methods and technologies to enable students to observe the surgical field more equitably, more clearly and from a closer perspective.\u003c/p\u003e \u003cp\u003eOne of the latest technological developments is the use of wearable smart devices (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The emergence of hands-free, wearable, interactive technologies such as smart glasses has encouraged researchers to further investigate their potential roles in clinical education (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In dental education, smart glasses contribute to improved clinical care by emphasising both distance learning and clinical practice. Integration of smart glasses in dentistry offers several advantages. They significantly enhance the dentists\u0026rsquo; workflow by enabling hands-free access to core knowledge, optimizing the clinical processes, and saving time. In dental education, smart glasses provide significant benefits by capturing the clinical procedures from the practitioner\u0026rsquo;s point of view and offering valuable learning experience for students (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost existing research focuses on the preclinical training period while studies evaluating clinical training environments remain insufficient. This inadequacy prevents a full understanding of the potential of video-supported methods during the critical internship period, in which dental students develop their clinical skills on real patients. Therefore, this study aimed to investigate the effects of three different methods used in dental clinical internship training [traditional internship observation, live video monitoring of the surgical procedure via a monitor in the classroom, and a hybrid educational method (the combination of traditional observation and live video monitoring of the surgical procedure)] on students\u0026rsquo; knowledge level, clinical awareness, observation skills, and overall learning experience. It is anticipated that the data obtained from this study will contribute to the development of student-centered, multi-observer\u0026ndash;based teaching approaches in clinical surgical education, the standardization of hybrid educational models, and the establishment of a scientific basis for future clinical training protocols.\u003c/p\u003e \u003cp\u003eThe hypotheses were tested in this study: [1] different educational methods will have differential effects on students\u0026rsquo; knowledge levels; [2] the hybrid observation method will enhance students\u0026rsquo; abilities to observe the surgical process, follow technical steps, and develop clinical awareness more effectively than the other methods; and [3] the hybrid observation method will yield the highest outcomes in terms of students\u0026rsquo; learning attitudes, motivation, and perceptions of professional development.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Study Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Non-Interventional Clinical Research Ethics Committee of Uşak University Faculty of Medicine, (decision no. 28), issued at its meeting on September 11, 2025. This study adopted a sequential explanatory mixed-methods design, in which quantitative data were collected and analyzed first, followed by qualitative analysis to further explain and interpret the quantitative results (17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size of the study was calculated using\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eG*Power 3.1.9.7 software. Similar studies in the literature comparing the effectiveness of educational interventions have reported that a effects size value of 0.50 is considered a \u0026ldquo;large effect size\u0026rdquo; and is commonly used as a reference for sample size calculations using G*Power (1, 18). This support from the literature strengthens the validity of the chosen effect size assumption. The significance level (\u0026alpha;) was set at 0.05, and the statistical power (1\u0026minus;\u0026beta;) was set at 0.80. According to analysis conducted for three groups, the required total sample size was calculated as 42. This method was preferred to ensure that the study achieves adequate statistical power and is conducted with an ethically appropriate number of participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents at Uşak University Faculty of Dentistry begin their Oral and Maxillofacial Surgery internship from the third year onward. This internship includes clinical and theoretical practices. Clinical practices become more intensive from the fourth year onward. They gain clinical and theoretical knowledge about advanced surgical procedures. This study included 94 students, with an average age of 23.1 \u0026plusmn; 0.9, who were 5th-year students at Uşak University Faculty of Dentistry, completed their Oral, Dental and Maxillofacial Surgery internship observation based on implant surgery during the specified study period and fully completed the questionnaire.\u003c/p\u003e\n\u003cp\u003eInclusion criteria for the study are as follows:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe 5th-year students of Uşak University Faculty of Dentistry must have completed their Oral and Maxillofacial Surgery internship during the study period.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eExclusion criteria for the study are as follows:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp; \u0026nbsp;\u0026nbsp;Students refusing to participate in the study\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp; \u0026nbsp;\u0026nbsp;Operations of patients who did not give informed consent for video recording and live video streaming of the operation could not be used as a data source for the video-assisted groups of the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp; \u0026nbsp;Students who had previously observed implant surgery prior to the study period\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp; \u0026nbsp; Students who were absent on the day of the operation observation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRandomization and Grouping\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifth-year students of Uşak University Faculty of Dentistry were divided into three groups using simple random sampling method, with a minimum of 29 students in each group. Randomisation was performed using the online random number generator at www.randomizer.org to prevent potential bias in group assignments.\u0026nbsp;According to the resulting list, the students were assigned to\u0026nbsp;\u0026ldquo;Traditional Observation\u0026rdquo;, \u0026ldquo;Live Video Streaming\u0026rdquo; and \u0026ldquo;Hybrid Observation\u0026rdquo; groups, respectively.\u0026nbsp;Randomization process was conducted by a neutral researcher who was not involved in the data collection process. Group allocation was concealed until the observation day, and students were not informed about alternative observation methods to minimize performance bias. Representative sample of images of the study groups\u003cu\u003e\u0026nbsp;\u003c/u\u003eare presented in Figure 1. The definitions of the study groups are as follows.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTraditional Observation Group (Group 1):\u003c/u\u003e The students observed the surgical procedures in the operating room in person, and followed the process under the guidance of a lecturer. No video recording or live video streaming support was provided during the surgical procedures. This method represents a traditional operating room-based observation widely used in dental clinical education.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eLive Video Streaming Group (Group 2):\u003c/u\u003e Students in this group followed the surgical procedures via live video streaming on a monitor located in the classroom, separate from the operating room. Students do not have physical access to the operating room.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eHybrid Observation Group (Group 3):\u003c/u\u003e Students in this group followed the surgical procedures both through traditional in-person observation and live video streaming on a monitor located in the operating room.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVideo Recording and Live Streaming System\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe video recordings used in the study were obtained using Ray-Ban Meta Wayfarer smart glasses (Ray-Ban, EssilorLuxottica, Milan, Italy). Ray-Ban Meta smart glasses were preferred due to their lightweight design, first-person perspective camera alignment, suitability for use in sterile environments and real-time wireless transmission capability without the need for additional equipment. These smart glasses feature a 3024 x 4032 pixel camera resolution, a 4-hour charging time, dual speakers, 5 microphones (Figure 2). They can be controlled via touch or voice and feature Wi-Fi-based live video streaming capabilities. Images were recorded from the first-person (trainer) surgical specialist\u0026apos;s perspective, and the camera was positioned within the surgeon\u0026apos;s natural line of sight to ensure a clear view of the patient\u0026apos;s oral tissues.\u003c/p\u003e\n\u003cp\u003eLive video streaming was carried out through a closed broadcasting system accessible only to the observation groups. For this purpose, a private, password-protected account was created on the Instagram platform and throughout the study. The account was managed exclusively by the research team, with access restricted to relevant student groups for a limited time. Data privacy was maintained throughout the broadcast, and patients\u0026rsquo; facial areas and identifying information were not visible at any stage. The footage obtained during the broadcast was not downloaded, archived or shared with third parties; they were used solely for simultaneous educational purposes. Following completion of the study, the account was permanently deactivated, and no digital broadcast content was stored.\u003c/p\u003e\n\u003cp\u003eLive video streaming and video display were conducted using ASUS-brand LED (Light Emitting Diode) monitors with a 2560 \u0026times; 1600 Retina resolution. \u003cem\u003eDepending on the study group, monitors were placed in the operating room or in the Faculty of Dentistry student study room.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eDuring transmission, video quality, colour contrast, and synchronization were monitored by a member of the research team and no technical malfunctions were observed. This equipment and transmission system were selected to enhance the quality of educational observation of surgical procedures and enable students to evaluate the procedures from multiple perspectives. (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools and Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted among undergraduate students studying at Uşak University Faculty of Dentistry who participated in the Oral and Maxillofacial Surgery observation internship during the 2025\u0026ndash;2026 academic year. Data were collected using anonymous survey forms on a voluntary basis. The study was conducted in accordance with the relevant ethical principles and regulations set forth in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eThe surgical procedures performed in the posterior jaw region (molar implant surgery) were evaluated within the scope of the research. Implant surgeries performed in the molar region were included in this study because access to this area is difficult and the field of vision is limited, which can negatively affect students\u0026rsquo; visual learning experience. However, the aim was to ensure that the training provided was of equal standards by conducting the study in similar regions. The study included patients who provided written informed consent for video recording during the operation and its use for educational purposes. Patients who did not consent to video recording during the procedure or did not provide written informed consent were excluded from the study. All surgical procedures were carried out by a surgical specialist in accordance with faculty standard protocols. The patients were informed that participation in the study was voluntary and that video recording would not affect the operation or the duration of it. In addition, students were informed that completion the questionnaire was voluntary and that their responses would not affect their academic status or individual performance.\u003c/p\u003e\n\u003cp\u003eThis study employed a mixed-methods design, integrating quantitative performance outcomes with qualitative interview data to provide a comprehensive evaluation of the educational intervention. In this study, a custom designed survey form was used to collect both quantitative and qualitative data. Questionnaire form was refined by the study team and a statistical consultant after reviewing comparable studies in literature. The draft of the questionnaire was submitted for expert review to assess its alignment with the study objectives, scope, clarity of statements, and content validity and was finalized following the necessary revisions based on the feedback received. The first section of the questionnaire (Appendix-1), consists of four questions related to the surgical area, the procedure performed, the anesthesia method used, and the radiological evaluation, designed to measure students\u0026apos; knowledge and awareness of the procedure during observation. The quality of observation and its educational contribution were assessed using thirteen items of the second section of the questionnaire. The third section of the questionnaire consists of an open-ended question that allows participants to evaluate their general views and experiences regarding the observation method in detail. The final section of the questionnaire asked students to provide qualitative comments on the study.\u003c/p\u003e\n\u003cp\u003eThe reliability of the questionnaire was assessed through a pilot study conducted with 30 students \u0026nbsp;(19) and Cronbach\u0026apos;s alpha coefficient was calculated as 0.953, which indicates excellent reliability. The content validity of the questionnaire was reviewed by experts in oral and maxillofacial surgery education and biostatistics and was \u0026nbsp;considered appropriate for the objectives of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe process of analyzing quantitative data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS software (Version 27.0; IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize the demographic characteristics of the participants and their responses to the questionnaire, presented as frequencies (n) and percentages (%). To evaluate the differences in categorical variables and student perceptions across the study groups, Fisher\u0026rsquo;s Exact test was utilized. This test was preferred due to the expected cell counts in the contingency tables being less than five, ensuring a more accurate analysis of the small sample size distributions. A p-value of less than 0.05 was considered statistically significant for all tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe process of analyzing qualitative data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the Standards for Reporting Qualitative Research (SRQR, Appendix-2) were followed to enhance the methodological rigor, transparency, and credibility of the qualitative results \u0026nbsp;\u003c!--[if supportFields]\u003e\u003cspan style='mso-element:field-begin'\u003e\u003c/span\u003e\u0026nbsp;ADDIN EN.CITE \u0026lt;EndNote\u0026gt;\u0026lt;Cite\u0026gt;\u0026lt;Author\u0026gt;O’Brien\u0026lt;/Author\u0026gt;\u0026lt;Year\u0026gt;2014\u0026lt;/Year\u0026gt;\u0026lt;RecNum\u0026gt;299\u0026lt;/RecNum\u0026gt;\u0026lt;DisplayText\u0026gt;(20, 21)\u0026lt;/DisplayText\u0026gt;\u0026lt;record\u0026gt;\u0026lt;rec-number\u0026gt;299\u0026lt;/rec-number\u0026gt;\u0026lt;foreign-keys\u0026gt;\u0026lt;key app=\u0026quot;EN\u0026quot; db-id=\u0026quot;9v095rdv7wswwzew52fpwpty090saaavfwd5\u0026quot; timestamp=\u0026quot;1775588677\u0026quot;\u0026gt;299\u0026lt;/key\u0026gt;\u0026lt;/foreign-keys\u0026gt;\u0026lt;ref-type name=\u0026quot;Journal Article\u0026quot;\u0026gt;17\u0026lt;/ref-type\u0026gt;\u0026lt;contributors\u0026gt;\u0026lt;authors\u0026gt;\u0026lt;author\u0026gt;O’Brien, Bridget C\u0026lt;/author\u0026gt;\u0026lt;author\u0026gt;Harris, Ilene B\u0026lt;/author\u0026gt;\u0026lt;author\u0026gt;Beckman, Thomas J\u0026lt;/author\u0026gt;\u0026lt;author\u0026gt;Reed, Darcy A\u0026lt;/author\u0026gt;\u0026lt;author\u0026gt;Cook, David A\u0026lt;/author\u0026gt;\u0026lt;/authors\u0026gt;\u0026lt;/contributors\u0026gt;\u0026lt;titles\u0026gt;\u0026lt;title\u0026gt;Standards for reporting qualitative research: a synthesis of recommendations\u0026lt;/title\u0026gt;\u0026lt;secondary-title\u0026gt;Academic medicine\u0026lt;/secondary-title\u0026gt;\u0026lt;/titles\u0026gt;\u0026lt;periodical\u0026gt;\u0026lt;full-title\u0026gt;Academic medicine\u0026lt;/full-title\u0026gt;\u0026lt;/periodical\u0026gt;\u0026lt;pages\u0026gt;1245-1251\u0026lt;/pages\u0026gt;\u0026lt;volume\u0026gt;89\u0026lt;/volume\u0026gt;\u0026lt;number\u0026gt;9\u0026lt;/number\u0026gt;\u0026lt;dates\u0026gt;\u0026lt;year\u0026gt;2014\u0026lt;/year\u0026gt;\u0026lt;/dates\u0026gt;\u0026lt;isbn\u0026gt;1040-2446\u0026lt;/isbn\u0026gt;\u0026lt;urls\u0026gt;\u0026lt;/urls\u0026gt;\u0026lt;/record\u0026gt;\u0026lt;/Cite\u0026gt;\u0026lt;Cite\u0026gt;\u0026lt;Author\u0026gt;Majid\u0026lt;/Author\u0026gt;\u0026lt;Year\u0026gt;2018\u0026lt;/Year\u0026gt;\u0026lt;RecNum\u0026gt;300\u0026lt;/RecNum\u0026gt;\u0026lt;record\u0026gt;\u0026lt;rec-number\u0026gt;300\u0026lt;/rec-number\u0026gt;\u0026lt;foreign-keys\u0026gt;\u0026lt;key app=\u0026quot;EN\u0026quot; db-id=\u0026quot;9v095rdv7wswwzew52fpwpty090saaavfwd5\u0026quot; timestamp=\u0026quot;1775588704\u0026quot;\u0026gt;300\u0026lt;/key\u0026gt;\u0026lt;/foreign-keys\u0026gt;\u0026lt;ref-type name=\u0026quot;Journal Article\u0026quot;\u0026gt;17\u0026lt;/ref-type\u0026gt;\u0026lt;contributors\u0026gt;\u0026lt;authors\u0026gt;\u0026lt;author\u0026gt;Majid, Umair\u0026lt;/author\u0026gt;\u0026lt;author\u0026gt;Vanstone, Meredith\u0026lt;/author\u0026gt;\u0026lt;/authors\u0026gt;\u0026lt;/contributors\u0026gt;\u0026lt;titles\u0026gt;\u0026lt;title\u0026gt;Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools\u0026lt;/title\u0026gt;\u0026lt;secondary-title\u0026gt;Qualitative health research\u0026lt;/secondary-title\u0026gt;\u0026lt;/titles\u0026gt;\u0026lt;periodical\u0026gt;\u0026lt;full-title\u0026gt;Qualitative health research\u0026lt;/full-title\u0026gt;\u0026lt;/periodical\u0026gt;\u0026lt;pages\u0026gt;2115-2131\u0026lt;/pages\u0026gt;\u0026lt;volume\u0026gt;28\u0026lt;/volume\u0026gt;\u0026lt;number\u0026gt;13\u0026lt;/number\u0026gt;\u0026lt;dates\u0026gt;\u0026lt;year\u0026gt;2018\u0026lt;/year\u0026gt;\u0026lt;/dates\u0026gt;\u0026lt;isbn\u0026gt;1049-7323\u0026lt;/isbn\u0026gt;\u0026lt;urls\u0026gt;\u0026lt;/urls\u0026gt;\u0026lt;/record\u0026gt;\u0026lt;/Cite\u0026gt;\u0026lt;/EndNote\u0026gt;\u003cspan style='mso-element:field-separator'\u003e\u003c/span\u003e\u003c![endif]--\u003e(20, 21)\u003c!--[if supportFields]\u003e\u003cspan style='mso-element:field-end'\u003e\u003c/span\u003e\u003c![endif]--\u003e, enabling readers to apply or transfer the results to their own situations, contexts, time, and populations (22, 23). This study was conducted using a phenomenological qualitative research design in order to explore dental students\u0026rsquo; perceptions and learning experiences related to surgical observation in depth. Phenomenology is an approach that aims to elucidate individuals\u0026apos; experiences, perceptions, and the meanings they attribute to a particular phenomenon (24). For this reason, it was chosen as an appropriate method to understand students\u0026apos; experiences with different surgical observation methods.\u003c/p\u003e\n\u003cp\u003eThe study sample consisted of students\u003cem\u003e\u0026nbsp;\u003c/em\u003ewho participated in implant surgery trainings held at a faculty of dentistry and experienced three different surgical\u003cem\u003e\u0026nbsp;\u003c/em\u003eobservation methods. In the qualitative data collection process, a purposive sampling strategy was used to reveal how students\u0026apos; perceptions of their viewing experiences were shaped within the context of different levels of knowledge. Criterion sampling, a type of purposive sampling methods was used. The criteria included participation in the relevant surgical observation and voluntary provision of feedback regarding the experience. Within this context, based on the responses to the knowledge assessment questions administered prior to the surgical observation process, students with the highest and lowest levels of knowledge were identified in each observation group. From among these selected students, participants were included in the interviews in a manner that represented approximately two-thirds of each group. The aim is to represent the diversity of experiences within the group while maintaining qualitative data depth and ensuring data saturation. \u003cem\u003eThus, the aim was for the qualitative data to reflect not only average experiences but also experiential diversity and extremes. In total, three groups were evaluated according to the surgical observation methods.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn-depth interviews, one of the fundamental methods of qualitative research, are most frequently used in healthcare settings and represent one of the most established qualitative data collection methods. Such in-depth interviews\u0026nbsp;are typically semi-structured, based on a small number of preplanned open-ended questions, and follow a progression-based line of inquiry.\u0026nbsp;The\u0026nbsp;strength\u0026nbsp;of in-depth interviews lies in their ability to analyze the research topic in depth and in detail from participants\u0026apos; perspectives (25).\u0026nbsp;The data were collected through a semi-structured interview form developed by researchers. In-depth interview questions were designed in a non-directive and open-ended manner to enable students to comparatively\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eevaluate their experiences with\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003edifferent observation methods. \u0026nbsp;The same questions were asked of all participants, and were asked to respond based on their own experiences with the observation method they had undergone. In-depth interview questions were designed to cover the level of visibility of the surgical field, learning experiences, perceived educational contribution, and advantages/disadvantages of the observation method. In-depth interviews were conducted after obtaining participants\u0026apos; written informed consent, and were audio recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e-How would you generally describe the surgical observation method you experienced? What were the most important aspects of this experience for you in terms of its contributions to your learning and professional development?\u003c/p\u003e\n\u003cp\u003e-How did your level of visibility of the surgical field affect your ability to understand and follow the surgical procedure?\u003c/p\u003e\n\u003cp\u003e-During this observation process, which aspects do you think you gained the most insight into? (e.g., use of surgical instruments, doctor\u0026ndash;patient communication, ergonomics)\u003c/p\u003e\n\u003cp\u003e-What are the strengths and limitations of the observation\u0026nbsp;method you experienced?\u003c/p\u003e\n\u003cp\u003e-Is there anything else you\u0026apos;d like to add regarding your experience observing the surgery?\u003c/p\u003e\n\u003cp\u003eAt the end of the in-depth interviews, participants were asked whether they had any additional comments. During the in-depth interviews, the concept of data saturation, which is commonly used in qualitative research on oral health (26, 27) and has been extensively studied in the research community (28), was applied. Participants were asked to reflect on their answers during the interviews until data saturation was achieved or no new information was obtained. The data collection process was terminated when new themes or concepts began to recur during the interviews, and additional interviews failed to make a meaningful contribution to the existing themes. This approach ensured that each group adequately reflected the diversity of experiences within the group. Interviews lasted an average of 30 minutes. All audio recordings were transcribed word for word after the interviews and prepared for qualitative analysis.\u003c/p\u003e\n\u003cp\u003eThe data obtained were analyzed using the content analysis method. The analysis process began with researchers becoming familiar with the data by repeatedly reading all interview transcripts. Following this stage, meaningful statement units relevant to the research purpose were identified from the participants\u0026apos; statements and these units were coded. The coding and theme creation processes were carried out using MAXQDA Analytics Pro (version 24.4.1) software to ensure the systematic organization of the data. MAXQDA software was chosen because it allows for the systematic coding of qualitative data, visual and analytical comparison of themes, and transparent monitoring of the analysis process. The analysis process was conducted using an inductive approach, with themes derived directly from participant statements without relying on a predetermined framework. Frequency values were used to more transparently reveal the dominance and distribution of the themes. However, these frequencies are not intended for quantitative generalization; they only aim to show the relative importance of themes and their level of visibility within the data. This approach is consistent with the descriptive quantification framework recommended in qualitative research.\u003c/p\u003e\n\u003cp\u003eThe coding process was conducted independently by two researchers in order to enhance the reliability of the qualitative analysis process.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eResearchers independently reviewed the interview transcripts, identified meaningful units of meaning, and generated preliminary codes.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFollowing the independent coding process, the codes were compared, and areas of disagreement were discussed and resolved. Inter-coder agreement was assessed using Cohen\u0026apos;s kappa coefficient, with a kappa value (\u0026kappa; = 0.79) indicating good agreement. The interviews were conducted by researchers experienced in oral and maxillofacial surgery education who were not involved in the academic assessment of the participating students. To minimize potential researcher bias, a neutral and non-directive interview approach was adopted during data collection. Reflexive discussions were conducted throughout the coding and analysis process, and independent coding by two researchers followed by consensus meetings helped reduce subjective interpretation and enhance analytic rigor. In order to ensure the rigor of qualitative research, the principles of credibility, dependability and confirmability suggested by Lincoln and Guba (29) were taken into consideration. The methodological rigor of the study was addressed in accordance with the reliability criteria suggested in qualitative research. Transferability was strengthened by detailed reporting of the research context, sample characteristics, and data collection process. Dependability and confirmability were supported by systematically conducting the analysis process, clearly defining the coding steps, and reaching a consensus among researchers (30). This process is consistent with current literature recommendations for increasing methodological rigor in qualitative research (24, 31).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 94 fifth-year dental students participated in the study. The participants were distributed into three groups: traditional observation (n=35), live-streaming (n=30), and hybrid observation (n=29). No statistically significant differences were observed between the groups regarding age, gender distribution, or prior clinical observation experience (p \u0026gt; 0.05), indicating a homogeneous distribution across the study (Table 1).\u003c/p\u003e\n\u003cp\u003eAnalysis of participants\u0026rsquo; responses to the four knowledge-based questions revealed a statistically significant difference between the groups only for the question on preoperative radiological evaluation (p = 0.009). For this item, the correct response rate among students in Group 3 (38.7%) was significantly higher than that of the other groups (Table 1). No statistically significant differences were observed between the groups for the remaining three questions (surgical area, type of surgical procedure, and anesthesia method) (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Comparison of correct answer rates for knowledge level questions\u003c/p\u003e\n\u003ctable style=\"border-width: medium; border-style: none; border-color: currentcolor; border-image: initial; width: 100%;\" cellspacing=\"3\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSubject\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance (p*)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThe group that showed the highest accuracy rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOperation field\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eType of surgical procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnesthesia method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRadiological evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGroup 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFisher\u0026rsquo;s Exact Test; p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eAccording to Fisher\u0026rsquo;s exact test results, statistically significant differences were found in various items between observation environment and students\u0026rsquo; attitudes (p \u0026lt;0.001). Specifically, the students observing in Group 3 reported the highest rates of positive responses for most attitude items (Table 2). The students in the hybrid observation group reported the highest rates of positive responses for items such as The ability to follow the sequence of surgical instrument use (Question 6) (93%), The ability to observe the surgeon\u0026apos;s interaction with the patient (Question 9) (100%), Complication management, Decision-making under stress, and The observation of patient behaviours (Questions 16 and 17), with all p-values \u0026lt; 0.001. Furthermore, the hybrid observation method was found to be significantly more effective than traditional and live video methods in terms of The educational value of the surgeon\u0026rsquo;s explanations (Question 12) (97%), Connecting theoretical knowledge with practice (Question 13) (97%), and Contribution to professional development (Question 15) (97%) (p \u0026lt; 0.001; Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eComparison of attitude scores according to observation environment\u003c/p\u003e\n\u003ctable style=\"width: 5.1e+2pt;border: none;\" cellspacing=\"3\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey Item (Abbreviated)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1 \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eThe ability to follow the sequence of surgical instrument use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e93.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAbility to observe patient communication\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eThe educational value of the surgeon\u0026rsquo;s explanations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e97.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eConnecting theoretical knowledge with practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e97.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eContribution to professional development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e97.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDecision-making under stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e94.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eThe observation of patient behaviours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e94.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Fisher\u0026rsquo;s Exact Test; p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, dental students\u0026rsquo; perceptions of their surgical observation were analyzed using content analysis, and three main themes along with sub-codes associated with these themes were identified. The themes were analyzed comparatively according to surgical observation methods [group 1, group 2 and group 3]. Table 3 presents the main themes, associated sub-codes, and their frequency distributions, with each theme supported by direct student quotations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eThemes, codes, and frequencies related to students\u0026apos; experiences observing surgery\u003c/p\u003e\n\u003ctable style=\"border-width: medium; border-style: none; border-color: currentcolor; border-image: initial; width: 100%;\" cellspacing=\"3\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTheme 1: Visual access and clarity of the surgical field\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLimited field of view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInability to see details\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncreased clarity with monitor/camera\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTheme 2: Learning experience and educational contribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEducational and productive experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eReinforcement of theoretical knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAbility to follow the steps of the process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTheme 3: Clinical Setting and Professional Awareness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSurgeon\u003c/strong\u003e and patient communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSurgeon positioning and instrument use\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eThe professional contribution of the clinical atmosphere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFrequencies (n) represent the number of times the relevant code was mentioned at least once in participant statements and are not intended for quantitative generalization; they are presented to reflect the relative dominance of the themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Visual access and clarity of the surgical field\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme encompasses\u0026nbsp;the experiences of students related to their ability to view\u0026nbsp;the surgical field. It was observed that\u0026nbsp;visual access had a significant effect on learning experience, depending\u0026nbsp;on the observation method.\u003c/p\u003e\n\u003cp\u003eGroup 1: \u0026nbsp;It was frequently stated that the field of view was inadequate and that the intraoral area could not be clearly visualized.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI could not see the inside of the mouth, and had difficulty understanding the procedures because we observed them remotely. (Student 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup 2: Although it was emphasized that the surgical field was clearly visible, occasional technical issues were reported.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Seeing the procedure from the surgeon\u0026rsquo;s perspective was very beneficial; although there were occasional freezes, I was able to clearly follow the procedures.\u0026rdquo; (Student 52)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGroup 3: The use of monitor support\u003cem\u003e\u0026nbsp;\u003c/em\u003ewas emphasized as significantly enhancing visual access.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We were able to clearly observe areas that we could not see directly, which made it easier for me to understand the procedures.\u0026rdquo; (Student 81)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2:\u003c/strong\u003e \u003cstrong\u003eLearning experience and educational contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme encompasses how students evaluate surgical observation in terms of the learning process. The learning experience was examined through students\u0026rsquo; ability to understand procedural steps, connect theoretical knowledge with practice, and their perceptions of professional development.\u003c/p\u003e\n\u003cp\u003eGroup 1:\u003cem\u003e\u0026nbsp;\u003c/em\u003eDespite the limited visual resources, it was noted that the instructor\u0026apos;s explanation facilitated learning.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Even though I couldn\u0026apos;t see the details, the process was educational thanks to what our instructor explained.\u0026rdquo; (Student 9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGroup 2: Provided positive feedback regarding the application of theoretical knowledge to practice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Seeing implantology, which we learned in theory, put into practice was very beneficial for me.\u0026rdquo; (Student 43)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGroup 3: The learning experience was observed to occur most frequently.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Watching it live and seeing the details on the screen helped me understand the surgery much better.\u0026rdquo; (Student 68)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Clinical Setting and Professional Awareness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme encompasses students\u0026rsquo; presence in clinical setting and their observations of dentist-patient-assistant interaction.\u003c/p\u003e\n\u003cp\u003eGroup 1: Although students were unable to observe the surgical field, they stated that experiencing the clinical setting was professionally valuable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I could not see the inside of the patient\u0026rsquo;s mouth\u0026nbsp;\u003c/em\u003e\u003cem\u003ebut observing the communication between the instructor and the patient, as well as the use of instruments, was highly beneficial.\u0026rdquo; (Student 3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGroup 2: This theme was expressed to a more limited extent in the live video streaming group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was beneficial to watch the procedure live but experiencing the\u0026nbsp;\u003c/em\u003e\u003cem\u003eatmosphere of the\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eoperating room would have been different.\u003c/em\u003e\u0026rdquo;\u003cem\u003e\u0026nbsp;(Student 58)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGroup 3: When clinical setting experience was combined with visual support, a high level of\u003c/p\u003e\n\u003cp\u003elearning was reported.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Being\u0026nbsp;\u003c/em\u003e\u003cem\u003ephysically present in the clinical setting and viewing\u003c/em\u003e \u003cem\u003ethe details on the screen increased my professional awareness.\u0026rdquo; (Student 74)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOverall, the qualitative findings revealed\u0026nbsp;that different methods of observing surgical procedures affect the students\u0026rsquo; learning experiences through different mechanisms. While observing from operating room contributed to experiencing the clinical atmosphere and observing\u0026nbsp;professional interactions, it remained limited in terms of visual access. The live video streaming method enhanced visual clarity, however it partially limited the clinical setting experience. In contrast, the monitor supported observation method in operating room emerged as the most comprehensive learning experience by offering visual access, learning effectiveness and clinical awareness together.\u0026nbsp;When these themes are considered together,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eit becomes evident that the methods of\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eobserving the surgical procedures shape students\u0026rsquo; learning experiences not only at the level of information transfer; but also through interrelated mechanisms such as visual access, cognitive processing and clinical contextual awareness.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study is one of the few studies evaluating the effectiveness of a live video supported hybrid observation method in dental clinical education. The findings of the study show that the hybrid observation method provides a significant advantage in enhancing students\u0026rsquo; knowledge level and improving their understanding of the critical stages of the surgical process. In line with the first hypothesis the findings indicate that educational methods have different effects on students\u0026rsquo; knowledge level; especially the hybrid observation method was found to be more successful than the other methods in accurately identifying pre-procedural radiological evaluation. Although four knowledge-based questions were included in the questionnaire, statistically significant differences between the observation groups were observed only for the item related to preoperative radiological evaluation. The absence of significant differences in the remaining knowledge questions (surgical area, type of procedure, and anesthesia method) may be explained by the relatively basic nature of these items and the comparable baseline theoretical knowledge levels of fifth-year dental students who had already completed the relevant coursework. These findings suggest that observation methods may have a stronger impact on interpretative clinical awareness than on basic factual knowledge acquisition. In line with the second hypothesis, the hybrid observation method significantly enhanced students\u0026rsquo; ability to observe the surgical procedures, follow the technical stages, and develop clinical awareness. In line with the third hypothesis the hybrid observation method was expected to have the greatest impact on students\u0026rsquo; learning attitudes, motivation and perceptions of professional development, and the findings have strongly supported this hypothesis. For this reason, all the hypotheses tested in this study are supported by the findings and were accepted. Significant differences were observed among the three methods in terms of students\u0026rsquo; knowledge levels, ability to observe surgical procedures, and learning attitudes, with the hybrid observation method found to be the most effective.\u003c/p\u003e \u003cp\u003eSmart glasses have the potential to enhance dental education, teaching, and clinical practice, serving as an innovative alternative both the educational and practical aspects of dentistry (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). A previous study reported that smart glasses may improve medical students\u0026rsquo; acquisition of various surgical skills in surgical education (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The Ray-Ban Meta smart glasses used in this study provided high resolution, providing real-time image transmission from the surgeon's first-person perspective, allowing students to observe the surgical process directly from the practitioner's viewpoint. The integration of the camera with the natural head position provided a high level of alignment between trainer\u0026rsquo;s field of view and the images observed by students on the monitors; thus the limitations frequently reported in traditional observation such as loss of viewing angle, crowding and physical positioning constraints were largely reduced.\u003c/p\u003e \u003cp\u003eThe live streaming capability supported real-time learning and offered a pedagogical advantage particularly in facilitating the understanding of the complex surgical steps. Accordingly, in clinical settings where physical space and viewing limitations are prominent, smart glasses supported hybrid observation methods may be considered a strong and applicable alternative for enhancing the quality of learning.\u003c/p\u003e \u003cp\u003eThis study showed that the hybrid observation methods had a significant impact on students\u0026rsquo; observational skills and learning process in cases where physical limitations of the operating room restricted students' learning experience. This finding supports the notion that technological integration may enhance the quality of learning, as also indicated in a systematic review related to digital dental education (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The findings of the study demonstrate that the hybrid observation method provides a significant advantage in enhancing students\u0026rsquo; knowledge levels and understanding the critical steps of the surgical procedure. Particularly in the question regarding radiological evaluation before the procedure, the higher rate of correct responses among students in the hybrid observation group compared with the other groups indicates that the visual continuity provided through the monitor supports the acquisition of knowledge. This finding is consistent with a study evaluating the effectiveness of different video types online learning, which reported that observation based videos more strongly support conceptual learning (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In this study, live streaming support enabled students to more clearly observe the scope of surgical procedure, the instruments used and the surgeon\u0026rsquo;s decision making process. Similarly, Qutieshat et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) reported that blended learning enhances dental students\u0026rsquo; clinical performance and satisfaction levels. This learning process, supported by both visual and auditory inputs, suggests that hybrid observation method contributes to cognitive learning as well as affective learning.\u003c/p\u003e \u003cp\u003eIn this study, the findings related to attitude questions also indicate that the hybrid observation method offers advantages in terms of the learning experience. Students rated the hybrid observation method significantly higher than other observation methods in terms of instructiveness of the surgeon\u0026rsquo;s explanations, linking the theoretical knowledge with practice, and contribution of professional development. This finding is consistent with literature indicating that video supported observation enhances students\u0026rsquo; cognitive engagement and sustained attention (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A study reported that video supported hybrid observation methods in veterinary surgical education strengthen the clinical awareness of students (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Similarly, consistent with our findings, Al-Elq et al.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) reported that hybrid video approaches in medical education enhance students\u0026rsquo; practical learning skills. In addition, our study also revealed the main difference between video-based observation method alone and hybrid observation method. Although students in live streaming group followed the overall flow of the surgical procedure, students in the hybrid observation group reported higher satisfaction with reviewing the visual and contextual aspects of the procedure. The opportunity to directly observe the surgeon\u0026rsquo;s communication, patients\u0026rsquo; reactions and complication management enabled students to develop a more holistic perspective on the clinical process. This finding supports the studies emphasizing that active observation and multisensory learning play an important role in clinical skills development (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). This finding particularly suggests that the hybrid observation method is the approach that most effectively facilitates students' understanding of material and their ability to relate it to processes. Although traditional observation and live streaming methods contribute to students\u0026rsquo; learning processes, the hybrid observation method received higher ratings in terms of clearly observing the surgical field, better understanding of procedural steps, and increasing clinical awareness.\u003c/p\u003e \u003cp\u003eA previous study reported that the model that includes live demonstrations and formative assessment improved students\u0026rsquo; orthodontics skills (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Similarly, another study reported that the flipped classroom approach combined with case based learning improved students\u0026rsquo; clinical decision-making and analytical thinking skills (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). These findings support that the hybrid observation method is a model that promotes active participation in clinical learning and strengthens practice skills. While Ramlogan et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) reported that video demonstrations in periodontology education did not significantly contribute to the students\u0026rsquo; tests results, our study showed that the hybrid observation method resulted in significant differences in both knowledge and attitude levels. This difference may be attributed to the method used in our study, which integrates the live transmission and observation in the operating room. The opportunity to observe surgical procedures simultaneously, from the surgeon\u0026rsquo;s perspective enabled students to shift from a passive viewer to an active observer. However, the findings of this study support the applicability of the hybrid observation method in dental education. Previous studies have also reported that video based and hybrid education practices support both cognitive and behavioral learning processes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Particularly, in surgical disciplines, when students cannot directly participate in observation due to limited physical space or infection control protocols, the hybrid observation method can ensure educational equality while preserving quality of education. In addition, the hybrid observation method can be easily implemented with low-cost hardware (e.g., Ray-Ban Meta Wayfarer smart glasses), which may offer a practical solution for dental faculties.\u003c/p\u003e \u003cp\u003eQualitative findings suggest that the learning outcomes of surgical operation observation cannot be reduced to a single factor; on the contrary they are shaped by the simultaneous interaction of visual access, cognitive integration, and clinical contextual experience. Within this context, the identified themes should be considered not merely as descriptive categories but also as functional components that structure students\u0026rsquo; surgical learning experience. This study offers a holistic model of learning mechanisms in surgical education by revealing the levels at which this different surgical observation methods activate these components.\u003c/p\u003e \u003cp\u003eAccording to the qualitative findings of this study, the process of operating room observation enables students to experience the clinical environment and understand surgeon-patient- assistant interactions, thereby supporting professional socialization and contextual learning. However, limited visual access restricted the cognitive processing. Live interaction demonstrations of clinical procedures have traditionally been quite effective in dental education. However, the integration of demonstrations has increasingly been adopted to improve teaching methods (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Observation via live video streaming facilitated the understanding of procedural steps by enhancing the clarity of the surgical field; however it weakened the contextual dimension of learning due to limited exposure to the physical and emotional component of the clinical environment. The limited effectiveness of using video demonstrations alone in the teaching of clinical skills, may stem from reduced student interaction and participation in this mode. Interaction and participation are crucial for enhancing student\u0026rsquo;s understandings and increasing their self-confidence (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). To mitigate this limitation, the hybrid observation method strengthens students\u0026rsquo; both cognitive and contextual learning processes by integrating visual access with clinical environment experience. In addition, students reported that the hybrid observation method provided significant advantages, particularly by enhancing the visual access, facilitating understanding of procedural steps, and maintaining attention during the lesson. Furthermore, it was observed that the hybrid observation method increased the students\u0026rsquo; motivation, helped them find surgeon\u0026rsquo;s explanations more instructive, and contributed to their understanding of the clinical process as a whole. These results indicate that the hybrid observation model is the most effective method for enhancing both cognitive learning and the quality of clinical observation. Overall, the hybrid educational method was evaluated by students as the most instructive and effective observation setting. Students\u0026rsquo; reporting of technical issues at minimal levels, together with high overall satisfaction, strengthens the feasibility and acceptability of the hybrid observation method. Similar to previous study, the current study also demonstrated satisfaction with the use of videos used in dental educatio (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Consistent with findings in the literature indicating that video-supported and hybrid models increase student motivation, focus, and clinical awareness (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), the results of this study suggest that the hybrid approach contributes not only to cognitive learning but also to affective and behavioral learning processes. The combination of quantitative and qualitative findings indicated that improved visual access (quantitative results) was supported by students\u0026rsquo; perceptions of increased clarity and a better learning experience (qualitative findings), thereby reinforcing the overall interpretation of the mixed-methods model.\u003c/p\u003e \u003cp\u003eThis study has some limitations. The research was conducted at a single center, and students\u0026rsquo; learning experiences were evaluated over a short period. Students\u0026rsquo; long term clinical learning outcomes, knowledge levels, and their effects on real patient practices were not evaluated. Only a specific surgical procedure was used in this study, which limits inferences regarding different levels of surgical difficulty. Some opinions may not be represented as qualitative data collection is based on voluntary participation. In addition, differences in equipment and technical infrastructure may affect the application when transferring the technology based hybrid observation method to other institutions. This study focused on students\u0026rsquo; learning experience. Future research is recommended to include multicenter designs, different surgical topics, long period follow-up, and objective performance metrics.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study shows that the hybrid observation model (both direct observation and live streaming) contributes positively to dental students\u0026rsquo; surgical education and that this method can serve as a strong complement to traditional education models. It reveals that surgical dental education can be accessible even under limited physical conditions and can be carried out effectively. The hybrid observation model provided students with a more holistic and instructive learning experience by combining the advantages of direct observation of the surgical field with the expanded viewing angle offered by live streaming transmission. First-person smart glasses videos have positively affected learning and the student experience in oral and maxillofacial surgery training by enhancing the perceptibility of surgical procedures. Future studies with expanded samples are recommended to more comprehensively evaluate the effects of hybrid education on long-term skill acquisition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandards for Reporting Qualitative Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Non-Interventional Clinical Research Ethics Committee of Uşak University Faculty of Medicine, (decision no. 28), issued at its meeting on September 11, 2025. Written informed consent was obtained from all participants prior to participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMuhammed Fatih Çiçek and Muhammet Fidan designed the study. Muhammed Fatih Çiçek and Muhammet Fidan conducted the methodology. Ahmet Caymaz, Muhammet Demirkaya, Muhammed Mustafa Sağer, Alperen Şamil Karabek, Defne Dayan and Çağla Saygın collected the data. Muhammed Fatih Çiçek and Muhammet Fidan analyzed the data. Muhammed Fatih Çiçek drafted the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eShqaidef AJ, Abu-Baker D, Al-Bitar ZB, Badran S, Hamdan AM. Academic performance of dental students: a randomised trial comparing live, audio recorded and video recorded lectures. \u003cem\u003eEur J Dent Educ\u003c/em\u003e. 2021;25(2):377-84.\u003c/li\u003e\n \u003cli\u003eMaggio MP, Hariton-Gross K, Gluch J. 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Saturation in qualitative research: exploring its conceptualization and operationalization. \u003cem\u003eQual Quant\u003c/em\u003e. 2018;52(4):1893-1907.\u003c/li\u003e\n \u003cli\u003eLincoln YS, Guba EG. Naturalistic Inquiry. Thousand Oaks (CA): Sage; 1985.\u003c/li\u003e\n \u003cli\u003eAhmed SK. The pillars of trustworthiness in qualitative research. \u003cem\u003eJ Med Surg Public Health\u003c/em\u003e. 2024;2:100051.\u003c/li\u003e\n \u003cli\u003eNowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. \u003cem\u003eInt J Qual Methods\u003c/em\u003e. 2017;16(1):1609406917733847.\u003c/li\u003e\n \u003cli\u003eAhmed WM, Azhari AA. Smart glasses in dentistry: technologies, use cases, and future directions. \u003cem\u003eBiomed Eng Comput Biol\u003c/em\u003e. 2025;16:11795972251404258.\u003c/li\u003e\n \u003cli\u003eSato T, Sandars J, Brown J, Rogers SN. Usefulness of smart glasses and point of view for suturing skills training in medical students: pilot study. \u003cem\u003eBMJ Simul Technol Enhanc Learn\u003c/em\u003e. 2020;7(3):173-5.\u003c/li\u003e\n \u003cli\u003eM\u0026uuml;ller LR, Tipold A, Ehlers JP, Schaper E. TiHoVideos: veterinary students\u0026rsquo; utilization of instructional videos on clinical skills. \u003cem\u003eBMC Vet Res\u003c/em\u003e. 2019;15(1):326.\u003c/li\u003e\n \u003cli\u003eAl-Elq AH. Simulation-based medical teaching and learning. \u003cem\u003eJ Fam Community Med\u003c/em\u003e. 2010;17(1):35-40.\u003c/li\u003e\n \u003cli\u003eKneebone R. Simulation in surgical training: educational issues and practical implications. \u003cem\u003eMed Educ\u003c/em\u003e. 2003;37(3):267-77.\u003c/li\u003e\n \u003cli\u003eSivarajan S, Soh EX, Zakaria NN, Kamarudin Y, Lau MN, Bahar AD, et al. The effect of live demonstration and flipped classroom with continuous formative assessment on dental students\u0026rsquo; orthodontic wire-bending performance. \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2021;21(1):326.\u003c/li\u003e\n \u003cli\u003eYang F, Lin W, Wang Y. Flipped classroom combined with case-based learning is an effective teaching modality in nephrology clerkship. \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2021;21(1):276.\u003c/li\u003e\n \u003cli\u003eDervisbegovic S, Laky M, Tur D, Grundnig J, Rausch-Fan X, Moritz A, et al. Educational videos as a teaching approach to enhance dental students\u0026rsquo; practical skills in preclinical courses. \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2025;25(1):1299.\u003c/li\u003e\n \u003cli\u003eAbed H, Demyati A. Effectiveness of e-learning method on exodontia for dental students: a theoretical domain framework study. \u003cem\u003eJ Dent Educ\u003c/em\u003e. 2025;89(8):1257-66.\u003c/li\u003e\n \u003cli\u003eRoshier AL, Foster N, Jones MA. Veterinary students\u0026rsquo; usage and perception of video teaching resources. \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2011;11:1.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"dental education, hybrid learning, smart glasses, maxillofacial surgery, video-assisted learning","lastPublishedDoi":"10.21203/rs.3.rs-9457604/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9457604/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eVideo-based and wearable technologies have the potential to enhance the learning experience by increasing visual access in clinical education, however these technological methods have limited evidence about the effects of observation awareness and learning experience of the interns in the dental clinical internship setting. The aim of this study was to examine the impact of different clinical observation methods used during practical clinical training of implant surgery, which is a minor oral surgical procedure performed in oral and maxillofacial surgery, on students’ clinical learning awareness and experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 94 participants from fifth-year dental students were included in the study and separated into three groups as \u003cem\u003etraditional observation group\u003c/em\u003e, \u003cem\u003elive video streaming group\u003c/em\u003e and \u003cem\u003ehybrid observation (traditional observation + live video streaming) group\u003c/em\u003e\u003cstrong\u003e. \u003c/strong\u003eFollowing the observation, a questionnaire comprising qualitative and quantitative data was administered to the groups. Data were collected using a structured questionnaire and open-ended questions that assessed students' observational awareness, learning experiences, and overall perceptions. Quantitative data were analyzed using Fisher’s Exact test (p\u0026lt;0.05), while qualitative data were collected through semi-structured interviews and analyzed using inductive content analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The hybrid observation method\u003cem\u003e \u003c/em\u003ewas\u003cem\u003e \u003c/em\u003efound to be significantly more effective than traditional and live video observation in terms of following the sequence of surgical instruments, professional development, decision-making under stress, and observing patient behaviours (p\u0026lt;0.001). In addition, the field of view and the ability to notice details were rated significantly higher in the hybrid and live video observation groups compared with the traditional observation group (p\u0026lt;0.001). Observation from the operating room facilitated the experience of the clinical environment and professional interaction but remained limited in terms of visual access (p\u0026lt;0.001). In contrast, live video observation improved visual clarity but provided a more limited clinical experience (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe method of\u003cstrong\u003e \u003c/strong\u003ehybrid observation provides students with a more comprehensive and instructive learning experience by integrating the benefits of direct observation of the surgical field with the wider field of view. First-person smart glasses videos have a positive impact on oral and maxillofacial surgery training and students’ education by enhancing the perceptibility of surgical procedures.\u003c/p\u003e","manuscriptTitle":"Integrating First-Person Smart Glasses Video into Oral and Maxillofacial Surgery Education: A Mixed-Methods Study on Student Learning and Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 14:26:13","doi":"10.21203/rs.3.rs-9457604/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T18:52:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T14:55:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T11:44:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215406342867720165411023646346605524992","date":"2026-05-13T13:04:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337020470855167977740065067455171389443","date":"2026-05-13T07:30:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95361140742357494486770957691167769343","date":"2026-05-10T16:32:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T05:05:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275986954597471583066944288316154926139","date":"2026-05-04T09:13:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-04T08:00:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-25T20:55:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-23T01:10:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-23T01:10:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-04-18T18:49:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6fd215da-f2ed-48ee-a2b8-44499b6a6824","owner":[],"postedDate":"May 12th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T18:52:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T14:55:00+00:00","index":49,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T11:44:22+00:00","index":48,"fulltext":""},{"type":"reviewerAgreed","content":"215406342867720165411023646346605524992","date":"2026-05-13T13:04:03+00:00","index":47,"fulltext":""},{"type":"reviewerAgreed","content":"337020470855167977740065067455171389443","date":"2026-05-13T07:30:12+00:00","index":46,"fulltext":""},{"type":"reviewerAgreed","content":"95361140742357494486770957691167769343","date":"2026-05-10T16:32:15+00:00","index":44,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T05:05:15+00:00","index":38,"fulltext":""},{"type":"reviewerAgreed","content":"275986954597471583066944288316154926139","date":"2026-05-04T09:13:39+00:00","index":37,"fulltext":""},{"type":"reviewersInvited","content":"9","date":"2026-05-04T08:00:10+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T19:09:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-12 14:26:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9457604","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9457604","identity":"rs-9457604","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}