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Analyzing the Influence of Admissions Criteria and Cultural Norms on Success in an International Dental Studies Program

Key words: admissions criteria, cultural norms, foreign-trained dentists, international students

Submitted for publication 08/22/07; accepted 11/09/07

	Abstract

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
This study determines the extent to which admissions criteria and cultural norms predict the success of a foreign-trained dentist in a United States dental educational program. Correlation and regression tests were applied to an eleven-year period from 1994 to 2004 of retrospective admissions data for 144 International Dental Studies Program students. Five cultural norms were derived from the collective cultural dimensions of a scholarly work of validated multinational surveys by Geert Hofstede. These five cultural norms are Power Distance (degree of inequality between "haves" and "have-nots" in a culture); Individualism (support for independent or group behavior); Long-Term View (deferred gratification versus quick results/rewards); Masculinity (emphasis on performance/outcomes versus socialization); and Uncertainty Avoidance (ability to cope with an uncertain future). Hofstede’s calculated country scores on these cultural dimensions applied to the students’ countries of education and their influence on students’ academic performance were assessed by correlation and regression analyses. Results showed that the TOEFL and National Board Part I examinations and the cultural norm of Long-Term View were the most positive predictors of grade point averages. The other four cultural norms studied were not predictors of success. Those who applied to the program more than once before being accepted did less well in the program, yet "less well" might have meant that they graduated with a 3.0 instead of a 3.5 GPA. Generally speaking, the more recent the graduated class, the higher the ending GPA has been. Admissions committees should determine if they want to invest the resources required to implement a multitude of admissions predictors to find the best of the qualified applicants.

Dentists trained outside of the United States and Canada create a highly qualified, diversified, and motivated pool of applicants who present with a unique combination of characteristics that must be assessed to determine applicants’ ability to succeed in the American dental school environment. These characteristics include the following: level of technical skills; currency and completeness of knowledge; English language proficiency; past dental practice experience; and ability to integrate into a foreign country and a different educational culture.

The International Dental Studies (IDS) Program at the University of the Pacific Arthur A. Dugoni School of Dentistry started in 1987. This study correlates admissions criteria with a student’s success in Pacific’s IDS program over an eleven-year period from 1994 to 2004. For the purposes of this study, "success" is defined as a student who completes the educational program and earns a degree without regard to the amount of time to completion.

In addition, five cultural norms based on Geert Hofstede’s book Culture’s Consequences: Comparing Values, Behaviors, Institutions, and Organizations Across Nations¹⁰ were evaluated for their influence on a student’s success in the dental program. Based on the student’s country of education, each cultural norm was given a value taken from Hofstede’s study and used in this study’s statistical calculations. These cultural norms describe a population’s tendency toward a particular characteristic, such as individuality. The cultural norms used in this study are the following:

• Power Distance. Within a culture, how strong is the inequality between the "haves" and "have-nots" in areas such as privilege, wealth, and power?
  
• Individualism. Does the culture tend to support independent behavior or group behavior?
  
• Long-Term View. Does the culture cherish deferred gratification or expect quick results?
  
• Masculinity. Does a culture see performance (in job and school) as more important than socialization?
  
• Uncertainty Avoidance. How does a culture cope with uncertainty about the future?
  

The purpose of this study is to add to the body of literature of admissions criteria for international dental programs in the United States, as well as to examine the influences that cultures play on a student’s ability to navigate the dental school curriculum in the International Dental Studies program at the University of the Pacific Arthur A. Dugoni School of Dentistry.

	Review of the Literature on Cultural Dimensions

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
Culture’s Consequences: Comparing Values, Behaviors, Institutions, and Organizations Across Nations by Geert Hofstede is a 500-page scholarly work that explored thinking and social action patterns of individuals from more than fifty countries worldwide. Four cultural dimensions are introduced based on values and attitudes expressed in a multinational survey conducted at two different time periods. The fifth cultural dimension (long-term view) is based on a new, different, and unrelated cross-national study that was performed in 1985.¹⁰

The first four cultural dimensions (power distance, uncertainty avoidance, individualism, and masculinity) were derived from a large-scale survey that was administered to IBM employees in seventy-two countries in 1968 and then again in 1972. The survey was given in twenty languages and resulted in 116,000 surveys collected. From 1971 to 1973, a similar but all-English survey was given by Hofstede to managers attending an international business school for training. This resulted in 362 surveys from managers from thirty countries. Hofstede discovered that responses by managers and IBM employees from the same country were correlated for certain questions on the IBM survey. According to Hofstede, this was the first hard proof that cultural characteristics that could be associated with country of birth or upbringing were not due necessarily to the organizational environment, but were due to individual values established early and carried throughout one’s career.¹⁰

The fifth cultural dimension, long-term orientation, was added when a survey of students in twenty-three countries was administered in 1985. The survey, called the Chinese Value Survey, was an instrument developed in Hong Kong by Michael Harris Bond with support from Hofstede. The respondents were 100 university students representing a variety of undergraduate majors from all class years and from Asian and non-Asian countries. Bond and Hofstede integrated the Chinese values with the four IBM dimensions. This fifth dimension (long-term orientation) was validated by the 1990–93 World Value Survey and other subsequent value surveys and studies.¹⁰

Hofstede then correlated these five cultural dimensions with the variables from 140 additional studies by other scholars. The additional studies were not related to each other, and it was also shown that the five dimensions were significantly correlated with geographic, demographic, and political country indicators. Hofstede concluded that these five dimensions exhibited validity over time based on findings from the twice-administered IBM survey, the business school survey, and the cross-correlation of the five cultural dimensions with 140 other studies.¹⁰

These five cultural values are based on the idea that people have unique "mental programs" that are shaped throughout their lives by family, school, and the workplace. Permanent mental programming represents the values that reflect the person rather than the situation. To separate the values that represent the person from the situation, Hofstede analyzed questions taken from the IBM survey. The IBM survey contained questions about a respondent’s job and his or her managers/management in four major areas: satisfaction, perception, personal goals and beliefs, and demographics. Situational responses were expected to be higher among the satisfaction questions, lower for the perception questions, and lowest for the personal goals and beliefs questions. Therefore, to reduce as much situational component as possible, personal values were derived mostly from the personal goals and beliefs questions, with some perception questions and one satisfaction question. Country values, called cultural norms, were derived from the theoretical reasoning and statistical analysis of the collective mental programs of values for each country. ¹⁰ The five cultural norms that emerged from Hofstede’s research are summarized here.

Distance
Distance, called "Power Distance" by Hofstede, is the magnitude of human inequality in areas such as prestige, wealth, power, and rights (privileges). In the Hofstede survey, Power Distance was measured by how frequently respondents viewed that employees were afraid to express disagreement with their managers—meaning the more often that employees are afraid to disagree with their managers, the greater the perceived power distance. According to Hofstede, an example of a societal norm where Distance is "low" is that all members should have equal rights; where Distance is "high," power holders are entitled to more privileges. In an educational environment, an example given by Hofstede of low Distance is "teachers are experts who transfer impersonal truths"; in high Distance societies, "teachers are gurus who transfer personal wisdom." In the Distance index of fifty countries and three regions that Hofstede studied, Malaysia, Guatemala, and Panama had the highest indices, while Denmark, Israel, and Austria had the lowest. The United States ranked thirty-eighth among the fifty countries, indicating its tendency towards a comparatively low Distance index.¹⁰

Individualism
Individualism is the way people live and interact together. Its opposite is "collectivism." In a society in which low Individualism is the norm, membership is ideal because there is an emphasis on belonging. With high Individualism, an individual’s quest for leadership is encouraged because there is an emphasis on individual initiative and achievement. In an educational environment in low Individualism cultures, Hofstede defines the purpose of education as learning how to do something and a student’s individual initiative is discouraged. In contrast, Hofstede states that, in a high Individualism culture, the purpose of education is learning how to learn and a student’s individual initiative is encouraged. Of the countries and regions studied, the United States, Australia, and Great Britain have the highest Individualism indices, while Panama, Ecuador, and Guatemala have the lowest.¹⁰

Long-Term View
Long-term and short-term orientation is based on old Chinese values derived from the teachings of Confucius: persistence and thrift (long-term) balanced against personal stability and respect for tradition (short-term). As a societal norm, a low Long-Term View is characterized as an expectation that there will be immediate gratification of needs. In high Long-Term View, deferred gratification is acceptable. In the Chinese Value Survey, twenty-three countries were studied. China, Hong Kong, and Taiwan had the highest Long-Term View indices, while the Philippines, Nigeria, and Pakistan had the lowest. The United States ranked seventeenth among the twenty-three nations, pointing to the tendency for a short-term perspective and expectation of quick rewards in American culture.¹⁰

Masculinity
Masculinity and femininity reflect different ends of a continuum defining individuals’ beliefs about what goals are important in life. Hofstede’s study reveals that women universally place more importance on social goals such as relationships and the physical environment, whereas men place more importance on "ego" goals such as careers and money. In the educational environment, low Masculinity cultures describe failing in school as a minor accident, and the average student is the norm. In high Masculinity cultures, failing in school is seen as a disaster, and being the best student is the goal. Japan, Austria, and Venezuela have the highest Masculinity indices, while the Netherlands, Norway, and Sweden have the lowest. The United States ranked fifteenth among fifty nations, indicating a tendency towards the value of "ego" goals over social goals.¹⁰

Uncertainty Avoidance
Uncertainty means that the future cannot be absolutely predicted, yet it is the future on which hopes and fears are projected. Extreme uncertainty could cause unbearable anxiety, so cultures have created alternative ways of coping with it. There are three coping mechanisms: technology, which includes any and all objects created by humans; law, which includes all formal and informal rules designed to guide social behavior; and religion, which is revealed knowledge of the unknown. An example of low Uncertainty Avoidance is "what is different is curious." Conversely, in high Uncertainty Avoidance, "what is different is dangerous." In the educational setting, students may attribute achievements to their own ability in a low Uncertainty Avoidance culture. In high Uncertainty Avoidance, students attribute achievements to effort, context, and luck. Uncertainty Avoidance is not the same as risk avoidance. Uncertainty is related more to the anxiety of the unpredictable future, whereas risk is related to the fear that an event may take place. Of the country and regions studied, Greece, Portugal, and Guatemala had the highest Uncertainty Avoidance indices, while Denmark, Jamaica, and Singapore had the lowest. The United States ranked forty-third out of fifty nations studied, which shows its tendency to have lower avoidance of uncertainty.¹⁰

Based on Hofstede’s ranked list of countries per cultural norm, the countries represented in the eleven years of IDS population are listed in order from highest index to lowest index in Table 1. The United States is included in the listings to give the reader some perspective of where this country falls in the scope of each norm. For example, for the norm of Individualism, the United States has the highest index, meaning it values independence, whereas Venezuela has the lowest index, meaning it values collectivism and conformity. The values for the norms used in the study’s statistical calculations were taken from Hofstede’s tables, and references to those tables are shown in Table 1. The reader is encouraged to examine the original source of the cultural norm data.

The Dental Admission Test (DAT) is the only standardized test used to compare students applying for U.S. dental schools.⁵ There is no corresponding test for foreign-trained dentists; however, it has become common to use the National Board Dental Examination (NBDE) and the Test of English as a Foreign Language (TOEFL) in place of the DAT. NBDE Part I, which tests basic science knowledge, is most commonly used. NBDE Part II, which tests clinical science knowledge, is used to a lesser degree.¹² The TOEFL evaluates reading comprehension, among other areas, just as the DAT contains a Reading Comprehension subtest. It has been shown that reading comprehension is a strong predictor for higher scores on the NBDE Part I.^4,5 Likewise, the TOEFL has shown some predictability for NBDE Part I scores for international students.^7,8

Studies have attempted to predict academic (didactic) grades for predoctoral students and for international students. The DAT Academic Average,^13,14 undergraduate science GPA,¹ and, in one instance, faculty interviews⁶ have shown positive correlation with academic grades for predoctoral students. Undergraduate grade point averages (GPAs) have also been predictive of NBDE scores,⁶ but the same is not necessarily true for foreign-trained applicants. Many international programs require transcripts from the applicant’s native dental school that are translated into U.S. GPAs.¹² Due to the extreme variation in educational systems and grading systems worldwide, no research has been done to study the effects of a foreign-trained student’s native GPA on his or her success in a U.S. dental program. However, since the NBDE Part I is a standardized test, it has been used as a predictor for overall dental school GPA in international programs.^7,8 In addition, the TOEFL,⁸ NBDE Part II, and dexterity tests⁷ have shown significant correlation for international students.

Manual dexterity is another skill that schools attempt to predict in applicants prior to admissions. In the United States, predoctoral admissions committees use the Perceptual Ability Test (PAT) score of the DAT as a standard of measure. In Canada, a carving dexterity test is given in addition to the PAT. The PAT generally has been weakly predictive of preclinical grades^3,13,15,16 and not at all predictive for clinical grades.¹³ One study showed positive correlation between the PAT and NBDE Part II.⁶ Stewart et al. argued that the PAT showed positive correlation with a state board and a bias towards males. However, they found that the association is weak and, once in dental school, females and males performed equally as well.¹⁷ Based on this research, Gray and Deem concluded that the PAT is only useful as a cognitive test,¹⁶ and Coy et al. suggested that it should only be used as a screening tool to identify weaker candidates.¹⁵ Gray et al. concluded that traditional tests such as the PAT and other measures have limited predictive value for clinical performance and observed that the skills of all students, males and females, converge over time as techniques are mastered.¹³

In the realm of international programs, there is no PAT equivalent for foreign-trained dental applicants. Some schools administer a manual dexterity test as part of the admissions process. Stacey and Whittaker determined that manual dexterity was the second most predictive indicator for final academic and clinical grade point average,⁷ while Simon et al. did not.⁸

Studies regarding faculty interviews have shown mixed results. Smithers et al. proved that the predoctoral interview positively predicted third-year clinical performance, but negatively correlated with first-year academic performance.¹⁴ In international programs, the faculty interview has not shown any significant correlation with academic or clinical success.^7,8

This study updates the body of literature on admissions criteria for international dental programs, as well as examines the potential influence that cultures may play on a foreign-trained dentist’s ability to succeed in the International Dental Studies Program at the University of the Pacific Arthur A. Dugoni School of Dentistry.

	Data Collection and Hypotheses

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
This study is a retrospective look at data gathered from the IDS admissions archives of the graduated classes from 1994 through 2004, which includes 144 students at the University of the Pacific Arthur A. Dugoni School of Dentistry. An Institutional Review Board exemption was obtained, as the data researched were historical in nature with no personally identifying information. The data resided in a secure database accessible only to the IDS program director and program manager. Only the data needed were exported to a spreadsheet; then, statistics were calculated through a social science software program for facilitating statistical analysis. Student names were excluded, but country of education was included.

Twelve independent variables and ten dependent variables were chosen for this study. The independent variables (abbreviated labels in parentheses) are National Board Dental Examination Part I (NBI), Test of English as a Foreign Language (TOEFL) composite score, Operative Dentistry technique test (O_Tech), Fixed Prosthodontics technique test (F_Tech), average faculty interview score (Int_Avg), number of times an applicant applied (Reapply), year of graduation (Year), cultural norm of Individuality (Indv), cultural norm of Distance (Dist), cultural norm of Long-Term View (Long), cultural norm of Masculinity (Masc), and cultural norm of Uncertainty Avoidance (Uncert).

The dependent variables were first-year didactic GPA (Q4_Did), first-year preclinical laboratory GPA (Q4_LabCl), first-year combined (overall) GPA (Q4_Comb), first-year Fixed Prosthodontics grade (F_Grade), first-year Operative Dentistry grade (O_Grade), second-year didactic GPA (Q8_Did), second-year clinical GPA (Q8_LabCl), second-year combined (overall) GPA (Q8_Comb), second-year Fixed Prosthodontics grade (Q8F_Grade), and second-year Operative Dentistry grade (Q8O_Grade).

Table 2 displays the descriptive statistics for the six admissions variables. In the past, the minimal TOEFL score for admissions was 550 and was later increased to 580. In the earliest years of the IDS program, the minimum scores were not enforced and, in some instances, not required. Hence, approximately 10 percent of the scores fall below 550, and there were eleven students who did not take the TOEFL. The minimum NBDE Part I score for consideration to the IDS program is 80. Again, in the earliest years of the IDS program, some of the students accepted from the alternate pool (after "initial accepts" had declined) had scores below 80. The Operative and Fixed Prosthodontics technique tests are designed to assess a candidate’s level of hand skills with scores ranging from 1 (Inadequate –) to 12 (Excellent +). Tracking the interviews and number of reapplies was started with the Class of 1999; therefore, there is missing data for fifty-seven students (before the Class of 1999). There was one student who was not interviewed even after interviews were instituted. Regarding reapplications, there were no students in the study who applied more than two times before they were admitted to the program.

Based on the descriptive statistics, the following research hypotheses were developed and, subsequently, the research question is stated:

• TOEFL is positively related to final dental school GPA.
  
• National Board Part I is positively predictive of didactic GPA throughout dental school.
  
• The Operative and Fixed Prosthodontics technique tests positively predict first-year and second-year laboratory and clinical grades.
  
• The interview score is not predictive of first-year and second-year overall GPAs.
  
• Students who apply more than once have lower overall GPAs than those who are accepted upon their first time applying.
  
• Cultural norms are associated with the success of a foreign-trained dentist in the IDS program.
  

The ultimate research question to be answered by correlation and regression analyses of the variables is this: Do admissions criteria or cultural norms correlate to the separate or combined GPAs in the two years of the IDS program?

	Results

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
Table 3 shows the bivariate correlation table for the twelve predictor variables and the ten outcome variables. The Year of Graduation, Reapply, TOEFL, National Board Part I, and Long-Term View variables had the strongest and most positive effects on the outcomes variables. Year of Graduation demonstrated strong positive correlations with each of the dependent variables, making it the strongest indicator of all the independent variables. This finding demonstrates that grades showed an upward trend for each successive class. The Reapply variable had a strong negative association with each of the criterion variables, with the exception of a single nonsignificant relationship with the second-year Fixed Prosthodontics grade. This indicates that students who apply more than once tend to do less well than those who apply only once and gain acceptance upon their first attempt. The TOEFL predicted Fourth Quarter didactics, Fourth Quarter Combined, Eighth Quarter didactics, and Eighth Quarter Combined grade point averages to a significance level of .00. The TOEFL also significantly predicted Fourth Quarter preclinical GPA and Eighth Quarter clinical GPA. The NBDE Part I similarly predicted Fourth and Eighth Quarter didactic GPAs as well as Fourth and Eighth Combined GPAs to a significance level of .00. The correlation of the TOEFL and NBDE Part I to the didactic grades demonstrated that a student’s ability to read and comprehend basic material significantly helps him or her in the educational program. The Long-Term View was significantly predictive of Fourth and Eighth Quarter didactics and Fourth Quarter Combined GPAs to a significance of .01. It also predicted the Eighth Quarter Combined GPA to the .05 level. This finding suggests that individuals from cultures that respect delayed gratification do slightly better in the IDS program.

Table 4 shows the correlation matrix of the independent variables. The concept of multicollinearity between two independent variables means that the two variables measure the same construct. TOEFL showed multicollinearity and a significant positive correlation with Year of Graduation (r=.48, p=.00) and negative correlation with Uncertainty Avoidance (r=–.36, p=.00). At r=.45 and p=.00, Masculinity showed multicollinearity with Individualism. Uncertainty Avoidance showed multicollinearity and strong negative correlation with each Individualism (r=–.46, p=.00), Long-Term View (r=–.37, p=.00), and Masculinity (r=–.60, p=.00). Lastly, the Fixed technique test showed a multicollinear relationship with the Operative technique test at r=.39. If two variables demonstrated multicollinearity, then one variable was eliminated from the regression equation to reduce the redundancy that both variables had with the outcome variable. Based on the correlation analysis and multicollinearity, four independent variables were dropped from the regression analysis of this study: TOEFL, Fixed technique test, Masculinity, and Uncertainty Avoidance. This left independent variables that correlated highly with the dependent variable—Eighth Quarter Combined GPA—but only minimally with each other.

The variables in Table 5 with the largest Beta were National Board Part I (B=.31), Year of Graduation (B=.27), and Reapply (B=–.26). These three variables were each entered as separate models in the regression analysis in the order of their absolute strength (National Board Part I first, then Year of Graduation, then Reapply) to determine the amount of variability each explained on the Eighth Quarter Combined (overall) GPA. In addition, since the cultural norm variables did not show any strong relationships in the correlation table, the three variables were entered as a separate model to see their effects on the criterion variable.

Table 6 shows the regression analysis. The Enter method was used for each of the variables: National Board Part I in model 1; Year of Graduation in model 2; Reapply in model 3; Interview Average and Operative technique test in model 4; Distance, Individualism, and Long-Term View in model 5. The multiple correlation coefficient of NBDE Part I was .37, indicating NBDE Part I variable. When Year of Graduation was added, the multiple correlation coefficient was .55, and the two accounted for approximately 31 percent of the overall GPA. The change in R Square by adding the Year of Graduation was .17 and remained significant at p=.00. When Reapply was added, the multiple correlation coefficient was .60, and the three variables together accounted for 36 percent of the variance of the overall GPA. The remaining admissions variables of Interview Average and Operative technique test accounted for another 5 percent of variance with a moderately strong correlation coefficient of .64. Lastly, after controlling for all the admissions variables, the cultural norms accounted for an additional 4 percent of variance and show a moderately strong multiple correlation coefficient of .67. Beyond model 3, the change in R Square ceased to be significant.

	Limitations

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
A limitation in the use of cultural norms in this study is that the country of education is used to represent the applicant rather than the applicant’s cultural heritage. If the applicants are educated in their country of birth, then it could be argued that the findings of this study are likely to be accurate. Conversely, if more of the applicants were born in one country but attended dental school in another, then this study would reflect to a lesser degree the true nature of the cultural orientation and belief systems of the student population.

In his book, Hofstede cautions scholars to be careful in interpreting data collected from individuals and drawing conclusions about societal cultures from them.¹⁰ By the same token, there are limitations in this study using country indices of cultural norms and applying them to a small sample of individual dental students. This may explain the lack of correlation of the cultural norms to any of the outcomes variables. An area for further research could include developing attitude and values surveys that are analyzed at the societal level and then applying them to the dental profession.

	Discussion

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
The hypothesis that the TOEFL is correlated to final dental school GPA was supported by this study. A student’s ability to read and comprehend biomedical and other scientific information communicated in textbooks, on the Internet, and in lectures obviously has a strong effect on overall academic success. Additionally, the TOEFL’s significant relationship with the lab/clinical grades may indicate that communication with faculty and patients is also important.

National Boards Part I were predictors of didactic grades in this research. There could be several reasons for this. Students with higher NBDE Part I scores could have had a stronger educational background in their countries, could have been stronger didactic students in their countries, or could be excellent test-takers. Exams at Pacific are modeled after National Board exams, which could explain strong correlations. However, as curricula become more integrated and move away from the standard lecture format, the format of local and national assessments should be re-evaluated to perhaps parallel newer methods of teaching and learning.

The weak and insignificant correlations of the Fixed and Operative technique tests raise a question as to their predictive usefulness in the admissions process. Manual dexterity tests are an attempt to determine if an applicant’s hand skills predict clinical success in the program.^1–3,7 However, it is well known that there are commercial study programs, such as the Duggan Institute located in Southern California (www.duggandds.com), that prepare candidates for exercises just like this. This means that applicants can be well prepared for an exam even if their clinical skills are not correspondingly competent. Different technical and procedural skills and how the skills are taught in dental schools around the world result in foreign-trained dentists who have different clinical skills upon entering the United States. For example, Japanese dentists are competent in posterior composites and have less training in posterior amalgams, while Indian dentists have less training in crown and bridge due to the fact that fixed prosthodontics is considered a specialty there.¹¹ On the other hand, other studies have shown that students start out with different levels of dexterity skills, but their skills (and ultimately grades) converge as the program progresses.¹⁵ In the years since this study (2004 to present), the clinical faculty for the IDS program have been looking into different preparations, grading calibration, and grading methods in order to develop a set of tests that could be more predictive of success. Hand skills of applicants from various parts of the world are an interesting topic for further discussion.

Faculty Interviews represented one of the weakest measurements of all the criteria in this study. As cited in other studies, interviews are fraught with bias and inconsistency and have typically weak correlations with other performance criteria.^7,14 However, the more structured the interview, the more valid it may become.¹⁴ Interviews may serve only to introduce a candidate to the school and may also allow a faculty member to assess other noncognitive aspects, such as communication skills and motivation.⁷

The data analysis supported the hypothesis that reapply applicants did not do as well as those who were accepted upon their first application attempt. Upon closer analysis, this makes sense. For example, applicants who are not initially accepted to any program must wait another year to apply again. As foreigners in the United States, these applicants may or may not be able to work in the dental field, say as dental assistants, during that year. They may choose to take the National Board exam again to increase their scores. Or, they might do nothing and just wait out another year. When those applicants reapply the following year, they are competing against applicants who may be more recently out of school, be more versed in the cognitive knowledge of the National Board exam, or have "fresher" hand skills. Once two-time applicants are accepted, their level of performance, in all areas, may not be the same as the first-time applicants who were accepted. This research shows that this is a significant predictor for the Pacific program.

Lastly, correcting for multicollinearity, the three cultural norms analyzed were Distance, Individualism, and Long-Term View. Long-Term View had the strongest correlation with didactic grades and overall grades. Its significance indicates that the cultures that support persistence, adaptation to new circumstances, and structured problem solving may develop students who have been slightly more successful in the international program. The cultural norm of Distance showed weak negative correlation with didactic grades. Those students with higher grades tend to come from cultures whose beliefs support greater equality, student-centered education, and openness with information that is not constrained by a hierarchical structure. The cultural norm of Individualism showed the weakest amount of correlation; it only negatively correlated to the preclinical Fixed course grade, and this correlation was so small that no significant conclusion can be generalized from its meaning.

	Conclusions

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
The findings from this study indicate that cultural norms, as measured in this methodology, play a limited role in students’ academic success in an international dental educational program for foreign-trained dental school graduates. Rather, there may be other subjective qualities in an individual that make a difference in that student’s motivation to succeed. It was not our intent to use these cultural norms for admissions purposes. The purpose of the study was, instead, to retrospectively determine if there were aspects of a culture that demonstrated any relationship with our international dental program. A notable finding is that the time-honored faculty interview of candidates was not identified as a predictor for academic success. Several studies point to noncognitive factors as needing further study in their role in admissions.^7,13,14

The fact that more recent classes in the International Dental Studies Program at the Arthur A. Dugoni School of Dentistry have been more successful and that applicants who apply more than once do not do as well leads us to conclude that any randomly picked and qualified applicant who has not applied before will be successful in our program. The more practical question to ask is whether it matters how successful a student is in the program. If all of the students graduate on time, then does it matter that a "reapply" student finished with a 3.0 final GPA, whereas a "non-reapply" student finished with a 3.5 final GPA? What might be interesting for future study is to determine if there is a certain level (e.g., cut score) below which students should not be accepted due to the probability that they may fail. Each year, applicants further surpass the minimum requirements for entry into the program. With more qualified applicants to choose from, it becomes harder to pick "the best." This study proves that it may not matter.

There are anecdotal claims that international applicants view the selection process for the International Dental Studies Program as "very fair" due to the number and variety of factors considered during the selection process. Although there have been other studies that search for the most efficient methods that predict success,⁷ at Pacific there are currently enough resources to consider each of the twelve factors for admission to the IDS program. While some schools accept applicants solely on the basis of a paper or electronic application, the admissions team at Pacific continues to believe that the human interaction of an in-person interview and the technical skills testing session demonstrate positive support for diligent effort as well as professional responsibility toward the applicants in order to maintain the applicants’ perceptions of a fair and thorough process.

	Author Information

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 
Dr. Itaya is Assistant Professor, Department of Dental Practice, and Curriculum Coordinator for the International Dental Studies Program; Dr. Chambers is Professor; and Ms. King is Director of International Students and Scholars for the International Dental Studies Program—all at the University of the Pacific Arthur A. Dugoni School of Dentistry. Direct correspondence and requests for reprints to Dr. Lisa E. Itaya, University of the Pacific, Arthur A. Dugoni School of Dentistry, 2155 Webster Street, San Francisco, CA 94115; 415–749–3319 phone; 415–749–3334 fax; litaya{at}pacific.edu.

	REFERENCES

Top Author information Abstract Review of the literature... Data collection and hypotheses Results Limitations Discussion Conclusions References

 

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