Student-generated multiple-choice questions enhance deeper learning in dental materials education: a randomized crossover trial

Abstract Background Dental materials education poses unique challenges due to the complex integration of scientific principles with clinical applications. Traditional teaching methods often fail to promote deep conceptual understanding. This study investigated whether the process of generating multiple-choice questions (MCQs) by students could enhance deeper learning, knowledge application, and critical thinking in dental materials education. Methods A prospective, randomized crossover study was conducted among second-year dental students (n = 64) at the Nair Hospital Dental College, Mumbai. The study comprised of two phases examining different topics of similar difficulty (dental restorative composites and glass ionomer cements). Following the didactic lectures, all students completed the pre-tests and were randomly allocated to the intervention (MCQ generation activity with faculty-moderated discussion) or control group (additional study time). After a washout period of two weeks, the groups were crossed over. The primary outcome was the difference in post-test performance between the groups. The secondary outcomes included performance across cognitive domains and student feedback. Data were analyzed using paired and independent t-tests, with mixed-effects models for crossover analysis. Results Sixty-two students completed both study phases. The intervention group demonstrated significantly higher post-test scores compared to controls in both phases: Phase 1 (approximately 76.8% ± 7.6% vs. 65.3% ± 8.9%, P < 0.001, Cohen’s d = 1.38) and Phase 2 (approximately 74.5% ± 8.1% vs. 63.9% ± 9.4%, P < 0.001, Cohen’s d = 1.22). The largest improvements were observed in application/analysis questions (Cohen’s d = 1.89 and 1.57 for phases 1 and 2, respectively). Mixed-effects analysis confirmed significant intervention effects (F = 42.36, P < 0.001) without period or carryover effects. Student feedback was positive, with approximately 87.1% of the students reporting enhanced understanding. Conclusions Student-generated MCQs offer an effective and scalable strategy for fostering deeper learning in dental material education. This process encourages active engagement, supports higher-order cognitive development, and can be seamlessly integrated into existing curricula with minimal resource investment. This approach can potentially enhance both academic outcomes and clinical readiness in dental education. Registry Clinical Trial Registry of India (ctri.icmr.org.in/), registration number- CTRI/2025/07/091029 Registration Date-16th July 2025.