Blended Versus Traditional Instruction for Pulpectomy Training: A Quasi-experimental, Multi-arm Study of Knowledge, Procedural Competence, and Satisfaction

Background Blended instructional designs (flipped classroom, problem-based learning (PBL), and online-guided learning) are widely adopted in health-professions education, but evidence on their impact on practical skills in pediatric endodontics remains limited. Objective The main objective of this study is to compare knowledge, procedural skill (objective structured clinical examination (OSCE)), and student satisfaction across four pedagogies for undergraduate pulpectomy training, while holding contact time, hands-on exposure, and faculty-to-student ratios constant. Methods A quasi-experimental, parallel-group study at Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India (January-October 2025). Interns were taught pulpectomy using one of four arms: traditional (control), glipped, PBL, or online-guided (SRIHER learning management system (LMS)). Outcomes were (i) knowledge (pre-/post-test MCQ test; prespecified analysis using analysis of covariance (ANCOVA), with post-test as the outcome, arm as the factor, and pre-test as the covariate), (ii) OSCE (weighted 50-point checklist converted to percentage; competency ≥60%), and (iii) satisfaction (Likert 1-5; subscales: engagement, clarity, confidence, applicability, and overall). Results Eighty students were included (n = 20 per arm). OSCE performance was high and similar across arms, with overlapping 95% CIs: traditional 69.0 ± 3.5%, flipped 68.2 ± 3.5%, PBL 69.5 ± 3.8%, and online-guided 68.5 ± 3.8%; overall 68.8 ± 3.6%. Competency (≥60%) was 100% in every arm (20/20 each). Satisfaction was uniformly high: overall (O1) was 5/5 across all students, and subscales were in the "agree-strongly agree" range. Knowledge scores showed modest pre-post improvement across arms (overall mean gain +0.43 points on a five-point scale), and change scores did not differ significantly between teaching methods (one-way analysis of variance (ANOVA) on gain scores, p = 0.515). Conclusions When instructional "dose" and hands-on practice are standardized, traditional, flipped, PBL, and online-guided formats yield comparable, high procedural competence and a uniformly positive learner experience for pulpectomy training. Curricular structure ensuring adequate guided practice may be more consequential for immediate skill than the specific didactic format. Multi-center randomized studies with standard settings and longer-term outcomes (retention and clinical transfer) are warranted.