ABSTRACT 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.
Calle‐Molina et al. (2026) studied this question.