How dental students make career choices: Observational, descriptive, and cross-sectional study

INTRODUCTION

Career choice is often not an easy decision, as it is influenced by various motivational factors. Previous studies^[1,2] highlighted the impact of socio-cultural and economic factors on choosing dentistry as a career. Specialization in dentistry remains a relevant topic of investigation in both developed and developing countries. Studies from both settings have indicated that practicing as a general dentist continues to be more common than pursuing a specialty.^[1-6] For example, in the United Kingdom, approximately 90% of dentists are general practitioners; however, when dental students’ opinions were surveyed, 56% expressed positive attitudes toward specialization.^[5] Therefore, policymakers require data on dental students’ future career preferences, particularly regarding specialty choices.^[6]

Several studies from around the world have investigated the interests of dental students in various dental specialties and the factors influencing those interests.^[4,6,7-11] Orthodontics, in particular, represents a unique dental specialty that differs from others in both its academic study and clinical practice. Consequently, some studies have specifically focused on exploring the factors that motivate dental students to pursue orthodontics.^[3,10,12]

This study aimed to investigate the factors that motivate students to choose dentistry as a career and to examine their perspectives on future specialty choices, with particular emphasis on orthodontics.

MATERIAL AND METHODS

The research ethics committee of the institution reviewed and approved the protocol for the study before taking any steps for data collection (Approval number: A0109023OR). Participation in the questionnaire was voluntary; completing the questionnaire was considered informed consent for participation. In addition, the questionnaire was a paper-based, non-identifiable questionnaire, which assured the students about the confidentiality of their data and that it would only be used for research purposes.

The subjects included in the study were 4^th (or 5^th) year undergraduate dental students from one public and one private university, respectively. A total of 421 students were invited to complete the questionnaire. The survey took place in May 2023, a few days before the final examinations of the year. One of the authors was available for the students to clarify any ambiguity. The questionnaire was administered to the student during their regularly scheduled classes. Completing the questionnaire took on average 10–15 minutes.

The questionnaire was adapted from previous studies.^[13-15] The original questionnaire was tested using a pilot representative sample of students who were not part of the study.^[13] In the present study, the questionnaire was tailored to the group to which it was administered. A pilot survey was done on a sample from each university to adjust the time needed to complete the questionnaire and to check the clarity of the questions for the students. The answers to the questions were designed as a five-point Likert scale where the scores were assigned so that very important=1 and not important=5. The questionnaire consisted of seven sections tackling dentistry as a general specialty and its subspecialties. Each section included several questions. The seven sections were (1) Demographic data, (2) Ambition: Which factors influenced your choice of dentistry as a career?, (3) Alternatives: Which factors influenced your choice of dentistry over medicine (If you had a chance to join medicine)?, (4) Vision: Which factors influence the choice of your future specialty (After graduation from dentistry)?, (5) Preference: Which specialty (ies) do you prefer most for your career?, (6) Alternatives: Which factors influenced your choice for orthodontics as a future specialty (If you choose orthodontics)?, and (7) Rationale: Which factors influenced your choice for a specialty other than orthodontics as a future specialty (If you did not choose orthodontics)?

The completed questionnaires were carefully checked to exclude incomplete or flawed responses. The data from the responses were then entered into an Excel sheet (Microsoft^® Office 2010). Data were analyzed using IBM Statistical Package for the Social Sciences software package version 20.0. (Armonk, NY: IBM Corp). Continuous data were tested for normality with the Kolmogorov-Smirnov test. Quantitative data were expressed as range (minimum and maximum), mean±standard deviation, and median. Categorical data were represented as numbers and percentages. Chi-square test was used to compare between two groups. Alternatively, the Monte Carlo correction test was applied when more than 20% of the cells had an expected count <5. The significance level was set at P ≤ 0.05.

RESULTS

A total of 421 students were invited to complete the questionnaire, of whom 164 (0.39%) responded. However, only 135 (32.1%) responses were included in the statistical analyses after excluding incomplete or flawed submissions. The valid responses were obtained from students at the private university (n = 73 [54.1%]) and the public university (n = 62 [45.9%]). The responses came from 78 (57.8%) females and 57 (42.2%) males, all from the same nationality and ethnicity. The mean age of the students was 22.35 ± 0.91 (median = 22.0 [20.0–26.0]).

Results also showed that factors that were most influential on the students’ choice of dentistry as a career [Table 1] were as follows; “passion (love to work as a dentist)” (n = 70 [51.9%]), “practical study/working with hand” (n = 63 [46.7%]), and “family advice to join dentistry” (n = 63 [46.7%]), while the least influential factor was the “advice from friends/to be with friends” (n = 20 [14.8%]). Students chose dentistry over medicine [Table 2] because dentistry offers “more practical training than medicine” (n = 81 [60%]), “shorter career path than medicine” n = 66 (48.9%), and “flexible working hours than medicine” (n = 51 [37.8%]). Only 28 (20.7%) thought that dentistry has the advantage of “Less working hours than medicine.”

The Chi-square test of association did not show a relationship between gender (female/male) or type of university (public/private) and the factors that may influence the students’ choice of dentistry as a career; the only association appeared between gender and passion (love to work as a dentist) (<0.001) with males tended more to prefer this factor.

When it comes to choosing a specialty after graduation from dentistry, factors that would influence the students’ choice were [Table 3] “passion/love” (n = 86 [63.7%]), “reputation/prestige” (n = 62 [45.9%]), and “money (High income)” (n = 58 [43%]). Restorative dentistry got the highest score from students (n = 75 [55.6%]), followed by endodontics (n = 67 [49.6%]), oral and maxillofacial surgery (n = 64 [47.4%]), orthodontics (n = 49 [36.3%]), and general dentistry 46 (34.1%). The least-scored high by students were dental biomaterials (n = 6 [4.4%]), dental public health (n = 13 [9.6%]), and oral pathology (n = 16 [11.9%]), as shown in [Table 4].

Orthodontics was chosen mainly for the following reasons [Table 5]; more art than science (n = 37 [27.4%]), less contact with blood (n = 28 [20.7%]), and money (high income) (n = 27 [20%]). The Chi-square test of association did not show a relationship between gender (female/male) or type of university (public/private) and the factors that may influence the students’ choice of orthodontics as a future specialty; the only association appeared between the university and the experience with a role model (P = 0.004) with student from the private university more influenced by this factor.

The most common reasons that caused students to consider other specialties than orthodontics [Table 6] were as follows; difficult to have a clinic specialized only in orthodontics (n = 32 [23.7%]), difficult to join a postgraduate orthodontic program (n = 29 [21.5%]), long-term commitment with patients (n = 26 [19.3%]), and starting an orthodontic clinic is expensive (n = 24 [17.8%]).

DISCUSSION

The survey used a paper-based questionnaire, which was preferred over an online questionnaire to maximize the response rate and to give direct explanations and instructions about the survey and the questionnaire to the students. The students included in the present study were pre-final and final-year undergraduate dental students who had studied almost all the courses in the various dental specialties, this is because a study by Harrison et al.^[16] reported that approximately 43% of the dental students in USA-based universities changed their opinions regarding postgraduate plans when approaching graduation.

In the current study, dental students chose dentistry mostly because they were passionate about the profession; they loved working as dentists and especially enjoyed the hands-on, practical nature of the study. The results also revealed an association between gender and passion, with males showing a greater inclination toward this factor, and between the university and experience with a role model, with students from the private university being more influenced by this factor. A pilot study^[17] that classified factors influencing career selection into intrinsic, extrinsic, and interpersonal dimensions found that the most influential factor in specialty selection was the intrinsic personal joy and motivation to work hard, while a moderate positive correlation was observed between selecting basic sciences for postgraduate studies and being inspired by a teacher.

Students, in the present study, preferred dentistry over medicine because dentistry offers more practical training, a shorter career path, flexible working hours, and a better chance for balance between work and other aspects of life. Interpreting these results suggests that students did not see dentistry as easier or lighter work but as more flexible than medicine. These results were in agreement with results from other studies.^[18,19]

When it comes to choosing a dental specialty, the results of the present study revealed that, when the students rated the factors influencing their choice of a future specialty after graduation, factors related to the specialty itself came first, with passion/love for the specialty, followed by reputation/prestige and practical study/working with hand. A previous study^[9] found that enjoying providing the chosen specialty was the most prevalent reason for selecting one specialty over others among dental students.

Over the years, the results showed that orthodontics was the most popular specialty, followed by oral and maxillofacial surgery;^[2,7,9] however, increasing interest in oral and maxillofacial surgery and pediatric dentistry was noted.^[9] In a UK-based study, oral surgery was the first choice for dental students (35%) followed by orthodontics (26%).^[5] In the present study, orthodontics ranked fourth after restorative dentistry, endodontics, and oral and maxillofacial surgery, respectively.

In the present study, the most frequently cited reason for choosing orthodontics was the belief that it is “more art than science.” In the previous studies, students who chose orthodontics were motivated by the passion for the profession and the perception of it as an intellectually challenging specialty.^[3,10] Shah et al.^[20] who explored undergraduate dental students’ perceptions of their profession – whether they viewed it as a service or a business. Using a visual analog scale with endpoints labeled “Healthcare Provider” and “Business Person,” the majority of respondents aligned themselves closer to the “Healthcare Provider” end. The responses from the current and the previous studies reflect a non-materialistic view of the specialty.

The reasons why orthodontics ranked somewhat lower among students’ preferences were attributed to several perceived difficulties. Students identified challenges such as establishing a private clinic specialized solely in orthodontics and the high competitiveness of postgraduate orthodontic programs, which offer only a limited number of positions each year. Consequently, many students tended to choose specializations that serve a broader segment of the dental market. Moreover, in challenging economic conditions, orthodontic treatment may not be considered a priority by most individuals or families. A systematic review^[21] reported that the financial status of parents significantly influences the decision to seek orthodontic treatment for their children. In addition, establishing a general dental clinic requires substantial investment, a sound feasibility study, and considerable effort to develop it into a successful and profitable practice.

In the present study, 31.1% of the students considered that their experience with a role model highly shaped their attitude toward their future specialty. Earlier studies showed the importance of mentoring when it comes to decisions about the future of dental students in the profession. Prior experience in the dental school and following exemplary faculty members highlighted non-educational factors that affect students’ decisions.^[9] This, in particular, is true when the students choose specialties where their clinical experience with patients during their undergraduate study was limited, such as orthodontics or pediatric dentistry. Therefore, the studies focused on the importance of role models and developing a system that guarantees students obtain sufficient guidance during their studies to enable them to make sound decisions when choosing their future specialty.^[5,9] The importance of mentoring has always been realized. Although about 81% of the young Swiss dentists who participated in a study about career prospects were children of parents with dental education, they showed interest in having institutional mentoring programs.^[22] Another study^[23] emphasized the role of mentors, among other factors, in motivating dental students in didactic and clinical courses, and also in beyond the school environment. Even a positive past experience with orthodontic treatment could motivate dental students to join orthodontic programs.^[24]

CONCLUSION

Dental students loved to work with their hands. They preferred dentistry over medicine because the study is more practical, offers a shorter career path, and provides more flexible working hours. Orthodontics ranked fourth among the students’ preferences due to the financial constraints associated with establishing specialized orthodontic clinic.