Diagnostic Accuracy, Satisfaction and Self‐Confidence of Dental Students When Classifying Dental Caries Lesions Using Simulation‐Based Experience and Photographs: A Randomised Crossover Study of Intervention Sequence

AIM: To evaluate the diagnostic accuracy, satisfaction and self-confidence of dental students when classifying dental caries lesions using simulation-based experience and photographs, and to examine whether the sequence of these interventions influences diagnostic performance. METHOD: A randomised crossover study was conducted with 37 second-year undergraduate dental students. Participants were assigned to one of two intervention sequences: Photograph-Simulation-based Experience (P-SBE) or Simulation-based Experience-Photograph (SBE-P). Each student completed four diagnostic attempts, two with photographs and two with simulation-based experience, using the Nyvad criteria. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUC) and pairwise discriminative accuracy (pAUC). Satisfaction and self-confidence in learning were measured using the National League for Nursing Satisfaction and Self-Confidence in Learning Questionnaire. RESULTS: Simulation-based experience demonstrated higher diagnostic accuracy than photographs in both sequences. In the P-SBE sequence, AUC increased from 79.7 (95% CI: 77.2-82.3) in the first photograph-based attempt to 93.2 (95% CI: 91.6-94.9) in the second simulation-based attempt. In the SBE-P sequence, AUC was also higher in the second simulation-based attempt, reaching 89.9 (95% CI: 88.1-91.7). Students also reported greater satisfaction, higher self-confidence and a more positive overall perception of simulation-based experience (p < 0.05). CONCLUSION: Simulation-based experience yielded higher diagnostic accuracy than photographs in this Nyvad-based educational context. The highest overall performance was observed when photographs preceded simulation-based experience, supporting the progressive and complementary use of both approaches in undergraduate cariology teaching. Simulation-based experience was also perceived as enhancing satisfaction and self-confidence in learning.