Pilot Study of Arts‐Based Learning for Oral Cancer Screening: Educational Outcomes

Inadequate oral cancer screening (OCS) represents a critical public health challenge. Despite dentists’ strong theoretical knowledge, screening implementation dramatically varies in practice [1]. Several unexplored contributing factors include cognitive biases [2] and underutilization of arts/humanities-based teaching methods enhancing empathy and observational skills crucial for lesion detection [3]. Those likely interact with other influences, such as clinician risk perception. Consequences are severe. Nearly three-quarters of US oral cancer patients receive late-stage diagnoses [4], when survival rates decrease from 87.5% (localized) to 37.8% (metastasized) [4]. While much attention focuses on gaps in practicing dentists, this innovation addresses upstream education to instill durable habits before clinical autonomy develops. Researchers developed “The Art of Oral Cancer Screening,” a virtual museum-based training experience (Figure 1) following a previously published framework and protocol [5] which details the broader implementation strategy and full development process, including artwork selection criteria, rationale, and team composition. It weaves artistic engagement with clinical education to transform how dental students approach OCS. The 60-min experience integrates six curated artworks serving as pedagogical instruments to develop clinically-transferable skills. Its architecture rests on five pillars: an immersive virtual reality environment; interactive learning through illness narratives and visual thinking strategies; systematic observation skill development; examination of disparities; and alignment with clinical guidelines from the American Dental Association and National Institutes of Health. The curriculum addresses oral cancer pathology, risk stratification, clinical presentations, screening protocol, healthcare access barriers, and provider bias mitigation. The experience was delivered as a structured, faculty-led session. To assess efficacy, a survey instrument (Appendix in the Supporting Information) assessed immediate knowledge gains and sustained changes in oral screening behaviors. Twenty-seven third-year dental students from Harvard School of Dental Medicine completed the experience in August 2024. The survey was delivered pre-experience, then 1, 3, and 6 months post-experience. To compare pre- and post-experience scores across all time points, survey questions were designated as assessments of student knowledge, attitude, or practice (KAP). Each response was dichotomized (correct or incorrect). Either the Chi-square test or Fisher's Exact Test compared the proportion of correct responses, with statistical significance set at p < 0.05. The proportion of correct answers significantly increased regarding questions assessing students’ attitudes and perception of their role downstaging oral cancer (96%–100%), knowledge about disparities (0%–19%), history taking practice and biases (59%–94%), screening practice and biases (63%–94%), and counseling practice and biases (4%–63%) (p < 0.05) (Figure 2A). The Kruskal–Wallis and subsequent pairwise Wilcoxon rank sum tests compared the proportion of correct responses per student across the four surveys (Figure 2B). The proportion of correct responses increased significantly between the pre- and 1-month post-surveys (0.45–0.60; p = 0.0058). There were no significant differences between the pre- and 3-month post-, pre-, and 6-month post-, 1-month, and 3-month post-, or 3- and 6-month post-surveys (p > 0.05). Additional qualitative feedback from students revealed deep engagement with both the educational content and socio-clinical dimensions of OCS (Figure 3). These results support the intervention's effectiveness in increasing short-term student knowledge, attitudes, and practice on OCS and suggest that “refreshers” are indicated to sustain longer-term impacts. This unique arts-based training addresses bias, empathy, and observational skills that could lead to earlier detection and improved cancer survival. R.B. conceptualized the curriculum. R.B. and T.J. developed the curriculum. R.B. built the virtual museum-based intervention and delivered it to dental students. E.A. conducted the statistical analysis of the survey data. B.B.D. coordinated and collected the data. All authors contributed to writing the manuscript and reviewed the final version prior to submission. We extend our sincere appreciation to Dr. Jason Silverstein, Dr. Neal Baer, and Dr. Marty Zeve of Harvard Medical School for their valuable feedback and editorial guidance throughout our master's program. The authors declare no conflicts of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.