J Dent Educ. 71(10): 1363-1369 2007
© 2007 American Dental Education Association
International Dental Education |
Comparison of Student Satisfaction in Public Versus Private Dental Schools in Brazil
Ana Chapper, D.D.S.;
Simone A. Campani;
Verônica da S. Paiva;
Camila de A. de Assis, D.D.S.;
Eduardo Garcia, Ph.D.;
Fernando A. Abreu e Silva, Ph.D.
Key words: education, public, private, dentistry, undergraduate dental education, dental students
Submitted for publication 12/05/06;
accepted 07/24/07
 |
Abstract
|
|---|
This study compared perceptions of the teaching and learning process of twenty-four senior dental students from a public school and fifteen from a private school by means of a questionnaire with direct questions. Another five students in each group completed a qualitative survey with five open-ended questions. The questionnaires assessed perceptions of the interaction between didactic and clinical content, the role of professors during the course, and their future professional practice in Brazil. Quantitative data were summarized as means and standard deviations and statistically analyzed with the Student t test, P<0.05. Qualitative data were analyzed using a content analysis method. The results revealed that the students in the private school had more positive perceptions than those in the public school of how much the didactic classes contributed to professional practice, the level of motivation for the topics discussed, and how well coursework related to clinical practice. Both groups mentioned the importance of the clinical component of learning and perceived that professors showed little commitment to the professional preparation of dental students. Students’ perceptions of their preparation to work in different Brazilian communities and with different segments of society varied widely. The qualitative analyses confirmed students’ dissatisfaction with their learning. No difference was found between students in the public and private schools in their assessment of how well prepared they were to enter the working market. These findings indicate that measures should be taken to improve the quality of teaching and the satisfaction of dental school students in Brazil.
In dentistry, clinical practice with patients under the supervision of qualified professors is a significant component of preparation. Clinical practice involves surgical procedures that have to be practiced and performed without causing harm to patients. Practice should be based on didactic and clinical courses, and knowledge application should be in agreement with guidelines of attention to and promotion of the health of the population.1,2
The reflection about the teaching and learning process in dentistry should not focus only on the information acquired during the undergraduate course, but also on the processes through which knowledge is acquired.3 This assessment includes the perceptions of senior students from different schools about their professional preparation and about how this preparation meets challenges of their daily practice, especially in countries with different economic and social realities such as Brazil. Therefore, it is important to conduct studies to understand the learning process in dental school and the means by which students construct health concepts, which are the basis for professional practice.
The dental curriculum in Brazil has at least 4,000 hours in an average four and a half years of coursework. The emphasis is on curative practices, techniques, and procedures, which include laboratory and clinical fieldwork. The curriculum in Brazilian dentistry courses has historically been considered inadequate for the country’s economic and social reality.4,5
Data from the questionnaires completed by senior undergraduate students during the Brazilian National Courses Examination (Exame Nacional de Cursos) and made available by the Brazilian Education Ministry (INEP/MEC) revealed that 56 percent of all senior students from the several dental schools taking the examination were unhappy about their education.6 Although the dental courses ranked seventh in the category of students with lower dissatisfaction rates (44.3 percent), this negative feedback about the quality of dental education requires the investigation of the reasons why almost half of the senior dental students in Brazil were dissatisfied with their education.4
Very little information is available about students’ perceptions of their learning experiences and professional preparation,3,7–17 especially in a comparison of the perceptions of students from private and public dental schools.10 Moreover, disconnection between educational institutions and communities has been denounced in the literature analyzing Brazilian dental teaching.2,5 Therefore, it should be interesting to investigate the perceptions of senior dental students about their teaching and learning processes during undergraduate studies and to compare the perceptions of Brazilian senior dental students from public and private schools of dentistry.
This study analyzed and compared the perceptions of the teaching and learning processes during undergraduate studies of senior dental students from a public and a private school of dentistry in Brazil.
|
Methods and Data Collection
|
|---|
The sample was comprised of twenty-nine students from a public school and twenty students from a private school taking their last semester of studies in dentistry in January to June 2006. Participants were selected by requesting research subjects from among senior undergraduate dental students present in a didactic class in the last semester of the dental program course. Each school graduates about forty students per semester. After the purposes and methods of the study were explained, research subjects anonymously filled out the survey instrument, which contained questions about teaching practices in their dental courses. This study was approved by the Ethics Committee in Research with Human Beings and Animals of Universidade Federal do Rio Grande do Sul (CEP/UFRGS no. 2006576) and is in agreement with Resolution no. 196/96 of the Brazilian Health Council (CNS/MS) and all other pertinent legislation.
Two questionnaires were used for the evaluation. The first consisted of twenty direct questions answered according to a 10 cm visual analog scale that showed only the minimal and maximal points of reference. Immediately below each question, the students had the opportunity to check a box to indicate if they did not understand the question. This questionnaire was completed by twenty-four and fifteen undergraduate students from the public and private schools, respectively, and only one student from the public school refused to complete it. In each group, another questionnaire with five open-ended questions was completed by other five students. The time to answer all questions was fifteen minutes.
The questionnaires contained questions to assess students’ perceptions of didactic classes during the undergraduate course, the interaction between didactic and clinical content, and the role of professors during the course. The questions assessing how prepared the students felt with respect to their future professional practice in Brazil addressed their perception of preparation to the following situations: a) to work in different Brazilian realities, which means working with different economic segments of society, which range from low-income communities and populations with limited access to health care services to the privileged who can afford private dental care; and b) to work at the three different levels of attention to health in Brazil: primary care, which consists of essential dental health assistance for all individuals and families in a community at a cost that the community and the country can afford; secondary care, which provides assistance in programs, systems, and services of outpatient treatment and at small hospitals of intermediate technology, and provides primary care and additional specialized treatment; tertiary care, which is assistance provided at general and large specialized hospitals and private offices, which concentrate advanced technology of greater complexity and serve as a reference for programs, systems, and services.
A sample size ratio of 0.8 and a standard deviation of 1.8 were considered to estimate the sample size in each group. It was specified that the study should detect a difference of 2 between the two groups on a ten-point scale. At a 5 percent significance level for a two-tailed test at 80 percent power, the study would require a total of twenty-nine students, sixteen in one group and thirteen in the other group. The sample size was estimated using the PEPI® 404 X software package.
The values for the 10 cm visual analog scale ranged from 1 to 10. Results of answers using the visual analog scale were summarized as means and standard deviations and compared using the Student test (P<0.05). The level of significance was set at 
=5%, and data were analyzed and processed using the SPSS® 11.0 software package.
The information in the open-ended (free response) questionnaires was analyzed using the content analysis method described by Bardin18 and Moraes.19
|
Results
|
|---|
Quantitative Analysis
The results of students’ perceptions of didactic classes are shown in Table 1
. In the analysis of how much the didactic classes contributed to their professional skills, mean values for students from the private school were significantly greater than those for students from the public school (8.26 ±1.71 and 6.95 ±1.76). Similarly, the students from the private school reported higher levels of motivation to study and learn the topics discussed in their didactic classes. No significant differences were found between the groups in the evaluation of content retention in the basic and clinical sciences.
View this table:
[in this window]
[in a new window]
|
Table 1. Means, standard deviations, and range of students’ perceptions of didactic classes during the undergraduate course according to dental school (Porto Alegre, 2006)
|
|
As shown in Table 2, statistically significant differences between the responses of the public and private school students were also found for interaction between didactic and clinical content. The private school students assigned greater mean ratings than the public school students to didactic teaching and clinical practice, didactic motivation for clinical application, and learning about the dentist-patient relationship. The mean perception values for the five questions shown in Table 2 for public school students ranged from 4.13 to 6.48 on the ten-point scale, whereas the values for the private school students ranged from 4.54 to 8.14.
View this table:
[in this window]
[in a new window]
|
Table 2. Means, standard deviations, and range of students’ perceptions of didactic and clinical content during the undergraduate course according to dental school (Porto Alegre, 2006)
|
|
The analysis of students’ perceptions of professors’ performance revealed statistically significant differences between the two schools as shown in Table 3. The values assigned to the perceptions by the private school students in the analysis of the help received from professors in the critical analysis of literature, interest in their professional education, and availability to answer questions and discuss dilemmas were greater than the values obtained for students in the public school.
View this table:
[in this window]
[in a new window]
|
Table 3. Means, standard deviations, and range of students’ perceptions of role of professors during the undergraduate course according to dental school (Porto Alegre, 2006)
|
|
In the analysis of how the students felt prepared for the work market, 68 percent of the students in the private institution had mean values between 4.96 and 8.38, whereas values for those in the public school ranged from 3.68 to 8.10. This difference between groups was not statistically significant. Means and corresponding standard deviations of the answers to this question are shown in Table 4. Also, no differences between the groups were found in the item about how comfortable the student felt about their preparation to work in different Brazilian realities and to work at the three different levels of attention to health in Brazil. The number of answers in this item varied because some questions were not understood by some of the students.
View this table:
[in this window]
[in a new window]
|
Table 4. Means, standard deviations, and range of students’ perceptions of future professional activity in Brazil and at different levels of attention to health according to dental school (Porto Alegre, 2006)
|
|
Qualitative Analysis
When asked about the contribution of didactic and clinical classes for their professional skills, students’ answers were "little" or "partial" contribution, but they reported that the practical component of the course was more important to develop these skills and emphasized that clinical classes complemented and fixed information they received in their didactic courses.
The students in both schools perceived that their professors had little interest in their professional preparation. For some students, professors focused their attention on evaluating the student’s performance instead of emphasizing the teaching and learning process. This perception is demonstrated in this quote: "I believe that there is some knowledge withholding by professors and that they are more concerned with evaluating than with transmitting knowledge, although they are qualified to do so" (student 2, private school).
Students agreed that the ability to deal with patients was learned gradually and taught all along the curriculum; no significant differences between schools were found in this item. In terms of the approach to different economic and social realities, students mentioned differences in the type of action in the public and private schools concerning budgets and treatment plans, as can be seen in the following quotes: "The course is concerned with attention to low-income people" (student 3, private school); and "We learned options and treatments with different costs" (student 1, public school).
The questionnaire also investigated at which of the three levels of attention to health the students felt better prepared to work. Some students in the public school did not know how to answer this question and checked that the question was not understood. The students in the private school answered that they were prepared to work at the three levels.
|
Discussion
|
|---|
This study analyzed senior dental students’ perceptions of the following topics related to the teaching and learning process in one public and one private dental school in Brazil: the interaction between didactic and clinical content, the role of professors during the course, the preparation to join the work market, and their future professional activity in Brazil. Also, the responses of the students from public and private schools were compared.
In the answers about didactic content and its association with clinical practice, senior students perceived that the application of contents to clinical practice was not satisfactory, although clinical classes complemented and reinforced contents. These results are similar to those reported by Fugill,12 who found student dissatisfaction with the lack of contextualization of the didactic knowledge they received. According to that author, this may be attributed to the fact that students do not have the experience necessary to classify and bring together didactic information and practice and because students do not always have the same clinical experience. The application of concepts to real-life situations based on clinical cases, approaching individuals or groups, and focusing on different social and economic realities should be part of clinical practice, and it should be the professor’s responsibility to promote learning by integration of knowledge, attitudes, and skills.
The characteristics of effective teaching associated with promoting learning that were described by the students in this study have been frequently reported in the literature.1,2,8,11–15 Some of these characteristics are associated with the learning process, such as making use of good technology, providing students with opportunities to apply new knowledge, stimulating interaction between students, and using models and demonstrations, whereas others are associated with the professors’ characteristics, such as using an interactive style (e.g., asking questions) and having the ability to give constructive and fair feedback. In this study, the questions about the role of professors during professional preparation revealed the greatest differences between students from public and private schools. The consumption demands and the need to satisfy the "client" in the private sector may help to explain the differences between the schools.
In this study, differences between the schools were found in students’ perceptions of learning about the dentist-patient relationship and confirmed that changes still have to be made to improve the teaching of this relationship. The teaching and learning process in health sciences involves patients as well as professors and students. According to Roger-Leroi,15 early clinical experience in a medical hospital, for example, can be useful for dental students to learn to communicate with patients correctly, but the usefulness of such experience greatly depends on the supervision that the students receive during this period. Several factors define the dentist-patient relationship, and they should be seriously studied along the professional preparation process.20 Some examples of these factors are the following: the ethical dimensions of the professional practice; the technological advances that establish new limits of intervention in health care; and the growing understanding of the health-disease processes, which leads patients to participate more in clinical decisions. However, according to Ribeiro,20 these essential elements of the dentist-patient relationship do not receive adequate attention and are not fully developed during professional preparation.
Students’ perceptions about the retention of basic scientific knowledge revealed the need to reinforce this area of study along the course. However, because of its methodological design, this study did not identify whether any area of basic knowledge could have been better retained, as observed in the study conducted by Last et al. in 2000.21
The finding that no differences between the groups of public and private school students were found in perceptions about the preparation to join the work market or to practice dentistry in the different segments of the Brazilian society may be because of the heterogeneity within the groups. A trend was found for students in the private school to perceive that they were better prepared to act in the primary sector of attention to health. These results differ from those reported by Ayers et al.,10 who conducted a study in U.S. public and private dental schools to compare students’ perceptions of community dentistry programs for underserved populations. Ayers et al. found that students from both types of schools expressed a preference for private dental practice versus public service and that students from the private school showed a greater preference for private practice than the group in the public dental school. The Brazilian Curricular Guidelines for Undergraduate Courses (Diretrizes Curriculares para os Cursos de Graduação) are designed to bring together basic scientific concepts and clinical practice in a way that prepares dental school graduates to focus on the oral health needs of all economic segments of the Brazilian society, which includes communities and populations that have been historically underserved and that have pressing dental problems. However, the application of these curricular guidelines has not eliminated health care disparities in Brazil. According to Silveira,22 an important argument in favor of the legitimization of curricular guidelines is the growing interest of newly graduated dentists in looking for positions in the public health sector. This interest is affected by market difficulties, which require that universities prepare students in their undergraduate courses to develop an understanding of the value of working in the public sector and of social sensitivity without overlooking technical qualifications.
Qualitative research investigates the comprehension of phenomena as they are experienced by the subjects themselves. In this study, descriptive surveys with open-ended questions were used to allow dental students to answer in their own words without restrictions. This questionnaire model is limited by the difficulty in interpreting the answers and the difficulty that some people have in expressing their ideas in writing. However, this did not limit the analysis or understanding of the students’ perceptions of the curricular topics that were investigated. Results in general demonstrated the dissatisfaction of senior students in two Brazilian dental schools with the quality of their learning.
Despite the limitations of this study, such as the small sample of volunteer students from only two dental schools, the differences found between public and private schools revealed the need to reevaluate attitudes and paradigms of opinion-makers—the professors—to affect students’ identities positively and, therefore, reduce methodological inadequacies and increase students’ satisfaction with their education. Expanded studies that focus on the perceptions of a larger sample of dental students throughout Brazil or that follow up respondents longitudinally should be conducted in Brazilian dental courses to improve the relationships between students and faculty and enhance the use of effective pedagogical processes in dentistry courses.
|
Conclusion
|
|---|
Despite the limitations of this study, it can be concluded that senior students in the private dental school had more positive perceptions than the students in the public school about how much the didactic classes contributed to professional practice and how well coursework related to clinical practice. Both groups reported that the clinical component of learning was critical to the development of competence and perceived that professors demonstrated minimal commitment to the students’ professional preparation. There was a wide variation of perceptions about the preparation to work in the different Brazilian realities and at different levels of attention to health.
|
Footnotes
|
|---|
Dr. Chapper is a graduate student, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Ms. Campani and Ms. Paiva are graduate students, Medical School, UFRGS, Porto Alegre, Brazil; Dr. de Assis was Temporary Guest Professor of Periodontololgy, School of Dentistry, UFRGS, Porto Alegro, Brazil; Dr. Garcia is Adjunct Professor of Medical Education, Pulmonology Program, Medical School, UFRGS, Porto Alegre, Brazil; and Dr. Abreu e Silva is Associate Professor of Pulmonology, Medical School, UFRGS, Porto Alegre, Brazil. Direct correspondence and requests for reprints to Dr. Ana Chapper, Rua Doutor Flores, 323, Sala 71, CEP 90020–123, Porto Alegre, RS, Brazil; 55–51–32289291 phone/fax; anachapper{at}hotmail.com.
|
REFERENCES
|
|---|
- Mossey PA, Newton JP, Stirrups DR. Defining, conferring and assessing the skills of the dentist. Br Dent J 1997; 182(4):123–5.[Medline]
- Krieger L, Moysés SJ, Moysés ST. Humanismo e formação profissional. Cad ABOPREV 2005; 1(1):1–8.
- Ashley FA, Gibson B, Daly B, Baker SL, Newton JT. Undergraduate and postgraduate dental students’ "reflexion on learning": a qualitative study. Eur J Dent Educ 2006; 10:10–9.[Medline]
- Associação Brasileira de Ensino Odontológico (ABENO). Alunos satisfeitos com odontologia. At: www.abeno.org.br/menu.html. Accessed: June 12, 2006.
- Freitas SFT, Kovaleski DF, Boing AF, Oliveira WF. Stages of moral development among Brazilian dental students. Int Dent Educ 2006; 70(3):296–306.
- Instituto Nacional de Estudos e Pesquisas Educacionais, Ministério da Educação (INEP/MEC). Sistema integrado de informações da educação superior. At: www.ensinosuperior.inep.gov.br/. Accessed: June 12, 2006.
- Rosen AC, Marcus M, Johnson N. Changes in role perceptions by first-year dental students. J Dent Educ 1977; 41(8):507–10.[Abstract]
- Gerbert B, Badner V, Maguire B, Martinoff J, Wycoff S, Crawford W. Recent graduates’ evaluation of their dental school education. J Dent Educ 1987; 51(12):697–700.[Abstract]
- Burzynski NJ, Rankin KV, Silverman S, Scheetz JP, Jones DL. Graduating dental students’ perceptions of oral cancer education: results of an exit survey of seven dental schools. J Cancer Educ 2002; 17(2):83–4.[Medline]
- Ayers CS, Abrams RA, McCunniff MD, Goldstein BR. A comparison of private and public dental students’ perceptions of extramural programming. J Dent Educ 2003; 67(4):412–7.[Abstract]
- Henzi D, Davis E, Jasinevicius R, Hendricson W, Cintron L, Isaacs M. Appraisal of the dental school learning environment: the students’ view. J Dent Educ 2005; 69(10):1137–47.[Abstract/Free Full Text]
- Fugill M. Teaching and learning in dental student clinical practice. Eur J Dent Educ 2005; 9:131–6.[Medline]
- Sharp HM, Kuthy RA, Heller KE. Ethical dilemmas reported by fourth-year dental students. J Dent Educ 2005; 69(10):1116–22.[Abstract/Free Full Text]
- Henzi D, Davis E, Jasinevicius R, Hendricson W. North American dental students’ perspectives about their clinical education. J Dent Educ 2006; 70(4):361–77.[Abstract/Free Full Text]
- Roger-Leroi V. French dental students’ perception of a period of instruction in a hospital department. J Dent Educ 2006; 70(3):307–14.[Abstract/Free Full Text]
- Victoroff KZ, Hogan S. Students’ perceptions of effective learning experiences in dental school: a qualitative study using a critical incident technique. J Dent Educ 2006; 70(2):124–32.[Abstract/Free Full Text]
- Muirhead V, Locker D. Canadian dental students’ perceptions of stress. J Can Dent Assoc 2007; 73(4):323.[Medline]
- Bardin L. Análise de conteúdo. Lisboa: Edições 70, 1979.
- Moraes R. Análise de conteúdo: limites e possibilidades. In: Engers MEA, org. Paradigmas e metodologias de pesquisa em educação. Porto Alegre: EDIPUCRS, 1994:103–11.
- Ribeiro ECO. Ensino aprendizagem na escola médica. In: Marcondes E, Gonçalves EL, org. Educação médica. São Paulo: Sarvier, 1998:40–50.
- Last KS, Appleton J, Ferguson DB, Stevenson H. The value of a questionnaire in assessing the acquisition and retention of basic science knowledge by dental students. Eur J Dent Educ 2000; 4:3–9.[Medline]
- Silveira LGC. Diretrizes curriculares nacionais para os cursos de graduação em odontologia: historicidade, legalidade, legitimidade. Pesq Bras Odontoped Clin Integr 2004; 4(2):151–6.
Top
Abstract
Methods and Data collection
