J Dent Educ. 72(6): 688-697 2008
© 2008 American Dental Education Association
Milieu in Dental School and Practice |
Which Factors Influence Students’ Selection of Advanced Graduate Programs? One Institution’s Experience
Sophia Saeed, D.M.D.;
Monik Jimenez, B.A., S.M.;
Howard Howell, D.D.S.;
Nadeem Karimbux, D.M.D., M.M.Sc.;
Cortino Sukotjo, D.D.S., Ph.D., M.M.Sc.
Key words: dental education, dental licensing, residency selection, gender, relationship status, dental specialty, general dentistry, clinical training
Submitted for publication 10/18/07;
accepted 02/22/08
 |
Abstract
|
|---|
The reasons that students choose certain specialties may be integral to the quality of specialty programs and the future of those specialties. The Harvard School of Dental Medicine (HSDM) has a high percentage (87.6 percent) of students who enroll in postgraduate programs. The goals of this study were to establish a baseline of factors that affect postgraduate program selection at HSDM and to determine if there was a significant difference in factor selection by gender, relationship status, graduation year, or choice to specialize versus choice to pursue advanced training in general dentistry. As a pilot study, we asked HSDM graduates from the classes of 2005 to 2007 to rank the importance of forty-two factors in selecting a field of dentistry and a particular program or institution within a specialty. Overall, students felt that intellectual content, challenging diagnostic problems, and possessing a special skill or talent unique to a specialty were the most important factors in choosing a field of dentistry. Influence of family members in dentistry was ranked as least important. In choice of a certain program or institution within a given field, clinical training and philosophy of training were ranked most highly. Students felt that the opportunity to moonlight was least important. Significant differences (p<0.05) were found regarding gender, relationship status, and students who chose to specialize versus those pursuing advanced general dentistry training. No significant differences were found among the students in different graduating classes.
The Association of American Medical Colleges (AAMC), the American Medical Association (AMA), and the National Residency Matching Program (NRMP) have tracked medical residency selection for several years.1,2 The graduate medical education census and the graduate questionnaire administered annually to all fourth-year medical students in the United States have allowed investigators in medical education to evaluate why students pursue a certain field, as well as track career and specialization trends over time.3–5
In dentistry, since the 1960s, the American Dental Association (ADA) has administered a survey of advanced dental education to all programs accredited by the Commission on Dental Accreditation.6 This survey gathers information from institutions on several aspects of programs they offer, including the first-year enrollment in all accredited specialty and advanced general dentistry programs in the United States. In addition, the American Dental Education Association (ADEA) annually administers a survey of dental school seniors, which gathers basic demographic data, seniors’ immediate plans after graduation, long-range career plans, reasons for choosing dentistry as a career, and information about parents’ career, education level, and income.7 Students pursuing postdoctoral education immediately after graduation are asked to select from a list of eleven options: the nine recognized specialties; programs in general practice residency (GPR) and advanced education in general dentistry (AEGD), which are combined into one option; and other. Very little information is collected on why students choose a specific field of study or program within that field, unlike similar surveys in medical education, which are more detailed. The method of distribution of senior surveys is also different: while ADEA asks each individual dental school to distribute a paper survey to seniors in whatever fashion it sees fit, the medical questionnaires are electronic and can be directly accessed by students on any computer with Internet access.
Statistics from the Harvard School of Dental Medicine (HSDM) from 2004 to 2007 show that an average of 87.6 percent of graduates continue their training in postdoctoral programs, with 72.9 percent specializing and 14.7 percent pursuing advanced training in general dentistry. Because of this high proportion of students who pursue postgraduate education, HSDM is an appropriate institution at which to begin defining the factors that influence selection of these programs.
The specific goals of this study were to establish a baseline of factors that affect postgraduate program selection at HSDM and to determine if there is a significant difference in factor selection by gender, relationship status, graduation year, or choice to specialize versus choice to pursue advanced training in general dentistry. This and future studies may help predoctoral programs improve mentoring and counseling about career pathways for their students. The results may also help postgraduate program directors to attract the most suitably matched candidates for their programs.
|
Methods
|
|---|
Using previously published literature8–12 on medical specialty selection as a guide, a questionnaire with forty-two factors that may influence a student’s selection of postgraduate program was created and approved by the Harvard Medical School Office for Research Subject Protection (IRB Approval #M12951-101). The factors were divided into two parts: Part I consisted of seventeen questions about why a student selected a particular field of study, and Part II consisted of twenty-five questions about why a student selected a specific institution’s program within a given specialty. All ninety-four students from the graduating classes of 2005, 2006, and 2007 were contacted by email, phone, or in person and asked to complete the questionnaire between October 2006 and February 2007. Thus, students in the classes of 2005 and 2006 had already graduated and were pursuing their post-dental school careers, while the class of 2007 was still enrolled as dental school seniors. Participants were asked to rate the importance of each factor on a reverse Likert-type scale of 1 to 5, using the following labels: 1=extremely important, 2=very important, 3=important, 4=minimally important, and 5=not important. Examples or explanations were not provided for the survey items; participants were asked to rank the factors based on their individual interpretations. The only identifiers on the survey were gender, relationship status, graduation year, and the institution and program in which the student had been accepted or was currently a resident. Relationship status was defined as "single," "married," or "in non-marriage relationship." Participants were also asked to state if the program they had been accepted to or were currently attending was their first choice selection.
All data were entered into Microsoft Excel 2003 (Microsoft, Seattle, WA) and analyzed using STATA 9 (College Station, TX). Variables from Part I and Part II of the questionnaire were ranked in order of importance to applicants based on the mean response for each item. Respondents who failed to rate a factor were excluded from the statistical analysis of that particular item. The distribution of responses for each item was substantially skewed due to a small to moderate sample size. Nonparametric methods were utilized to test for significant differences among subgroups. The Wilcoxon rank sum test was used for subgroup analysis by dichotomous variables (gender, specialty vs. no specialty). For subgroup analysis by categorical variables (relationship status, graduation year, program type), the Kruskal-Wallis test was used. Statistical significance was assessed at alpha=0.05. Pairwise comparisons were made using Tukey’s procedure.
|
Results
|
|---|
The overall response rate was 71.3 percent (67/94), with 50.0 percent response from the class of 2005, 73.5 percent response from the class of 2006, and 90.0 percent response from the class of 2007. Table 1
shows the demographics of the sample population broken down by gender, graduation year, relationship status, whether the program was the student’s first choice, and the type of program. None of the respondents reported plans to enter the fields of Dental Public Health, Oral and Maxillofacial Pathology, or Oral and Maxillofacial Radiology.
Part I
Variables focusing on why a respondent chose a particular field of study were ranked based on mean (Table 2). Possession of special skills or talents unique to a specialty was the factor that was ranked the highest. Also ranked highly were intellectual content of the specialty and challenging diagnostic problems. Least important was influence of family members in the dental profession. No significant differences were found between the genders, graduation year, or relationship status. Significant differences (p<0.05) were found between respondents choosing to specialize and those choosing general dentistry (Table 3). Those who specialized valued more highly the possession of special skills or talents unique to their specialty (p=0.00), intellectual content of the specialty (p=0.00), challenging diagnostic problems (p=0.00), prestige within the dental profession (p=0.01), and lack of overcrowding in the field (p=0.04) (Figure 1). Respondents who chose general dentistry more highly valued the factor "unsure of specific specialty or enhancement of clinical skills" (p=0.00); however, this interpretation is skewed since only thirty-six responses were received for this item. While 80.0 percent of those who did not specialize ranked this factor, only 46.2 percent of those who specialized gave a response. Because there was no option for respondents to indicate that an item was "not applicable," those who felt the item did not apply to them may have chosen not to provide a response or may have ranked the factor as "5=not important."
View larger version (17K):
[in this window]
[in a new window]
|
Figure 1. Part I and Part II variables with statistically significant differences between respondents who specialize and those who pursue general dentistry
|
|
Part II
These variables were also ranked based on mean (Table 4). Clinical training, philosophy of training, and intuitive feeling about the program were ranked as the most important factors. Least important were availability of electives and moonlighting opportunity. No significant differences were found between graduation years. Significant differences (p<0.05) were found regarding gender, relationship status, and choice to specialize (Table 5). Females found geographic location (p=0.00) and proximity to family of origin (p=0.01) to be more important than males. Males found it more important than females to have the opportunity to moonlight (p=0.00) (Figure 2).
Students in a non-married relationship were more greatly influenced by house officer satisfaction (p=0.01) and their general impression of programs at interviews (p=0.02) than were single students (Figure 3). They also valued the impression of the program director significantly more than did married students (p=0.01). Married students and those in a non-married relationship were more greatly influenced by their spouse or significant other than were single students when deciding which program to select (p=0.00). Single students and those in a non-married relationship valued climate (weather) more highly than did married students (p=0.03).
Respondents who chose to specialize found it more important than their nonspecializing counterparts to consider clinical training (p=0.00), high volume of patients (p=0.04), prestige of the program (p=0.01), prestige of the department and faculty (p=0.00), advice from a mentor (p=0.01), and the opportunity to conduct research (p=0.00) when selecting a particular program (Figure 1
).
|
Discussion
|
|---|
The literature regarding factors that influence postgraduate program selection in dentistry is sparse and limited to certain specialties.13,14 One reason this may be true is that whereas medical students are required to complete a residency after graduation, dental students may begin practicing directly after four years of dental school and completion of licensure requirements. According to ADEA, 38.6 percent of dental school graduates pursue a residency in advanced general dentistry or one of the nine recognized dental specialties: Orthodontics and Dentofacial Orthopedics, Pediatric Dentistry, Periodontics, Prosthodontics, Oral and Maxillofacial Surgery, Oral and Maxillofacial Pathology, Oral and Maxillofacial Radiology, Endodontics, and Dental Public Health.7 The state of New York’s dental board was the first to implement a law in 2005 requiring a residency program in lieu of practical licensing exams; some other state dental boards have indicated plans to follow suit.15,16 As this trend continues, we hypothesize that a higher percentage of students will pursue postdoctoral training, though further studies are necessary for this question to be answered.
Many of our findings are consistent with those in the medical education literature.4,9–11,13,17–20 It is not surprising that people who choose dentistry and medicine as career paths value intellectual content and challenging diagnostic problems. Both fields require a long commitment to education and training and are quite selective in their admissions. An investment in a dental or medical education is also quite expensive; however, in our study and the existing medical education literature, good income and educational debt are ranked as moderately important while the factor of predictable work hours is ranked relatively highly. The desire for a controllable lifestyle is becoming more commonplace.18,21–23
Overall, clinical training and philosophy of training were the most important factors reported by our respondents when selecting a specific program within a given field of dentistry. A 1993 study in medical residency selection found similar results, implying that the structure and setup of the program are key in a student’s program selection.10 Our study demonstrates the importance of intuitive feeling about a program, impression of the program director, house officer satisfaction, and candidates’ impression at the interview, the latter two of which are consistent with the medical education literature.11
It should be noted that 31.3 percent of our sample chose to pursue Orthodontics, while only 7.5 percent each chose Periodontics and Prosthodontics (Table 1). Though our sample was not large enough to stratify each factor by program, a larger study sample may demonstrate specific differences within the groups that choose one specialty over another.
Gender and Relationship Status
With nearly an equal percentage of male and female participants, it is notable that no significant differences were found between genders in determining a field of study. This may indicate more equality in lifestyle, career, and goals between men and women in dentistry; however, this may be negated by the findings in determining a specific program within a specialty.5,8 Females have a greater preference than males in geographic location and proximity to family of origin, while males place greater importance on moonlighting. In a follow-up study, it might be interesting to ask why males and females make these choices. It may also be pertinent to see if ethnicity8,24,25 or religious affiliation confound the gender differences.
A fairly equal percentage of respondents were single, in a relationship, or married. As with gender, there were no major differences among these three categories when determining a field of study. However, there were differences after individuals decided which type of program to pursue. It was expected that students in a relationship would be more similar to married students in some aspects and more similar to single students in other aspects. It is no surprise that students in a relationship or married place greater value than single students on the influence of their spouse or significant other. There is no clear explanation as to why students in a relationship would be more influenced than single students by house officer satisfaction or general impression of programs at their interview, nor is there any clear explanation why they are more influenced than married students by the impression of the program director at their interview. The finding that single students and those in non-marriage relationships valued climate more highly than married students indicates that married students may place higher priority on other factors. Again, ethnicity8,24 or religion could be confounders, as could age and financial responsibility of children.
Specialty vs. General Dentistry and Graduation Year
Dentistry and all of its clinical specialties require a high level of training and talent. Third-and fourth-year dental students have greater procedural training than their medical school counterparts. They are responsible for the management and direct care of their own patients, under the supervision of a licensed dentist. While general dentistry requires knowledge and skill in many different areas, it is not surprising that students who choose to specialize highly value their possession of a special skill or talent unique to that specialty. The medical education literature demonstrates that students who select procedural specialties rank prestige of the department and faculty highly,20 as do dental students who choose to specialize. Dental students who specialize are also greatly influenced by clinical training, high volume of patients, opportunity to conduct research, and advice from a mentor. It was unforeseen that length of residency was not ranked significantly differently by those specializing and those not specializing, even though residencies in general dentistry are one to two years and those in specialties are two to six years.
The questionnaire was distributed to all three graduating classes while they were at differing levels in their training; the class of 2007 was just completing predoctoral studies, the class of 2006 was completing the first year of their programs, and students in the class of 2005 were finished with their program or nearing the end of their second year. There was also an unequal proportion of respondents from each of the three graduating classes. There were no significant differences among graduating classes in any of the categories measured.
Limitations of Study Design
The overall design of this study proved effective for our goals; however, we acknowledge that there is room for improvement. First, to prevent misinterpretation, definitions of the variables should have been provided with the questionnaire. Second, a focus group17 or pilot questionnaire8 could help us assess if all of the most important factors are listed and if they are interpreted by the participants the way we intended. Inclusion of some open-ended questions would allow for clarifications and additional comments, although those responses can be difficult to standardize and quantify.
To better understand the data, it would be useful to group the factors into larger categories such as lifestyle, remuneration, and dental school experiences.8–10,22,23 Some factors such as income, salary, benefits, call schedule, and educational debt may be relevant to both field of study and specific program chosen. Within a given field, some programs are paying while others require a tuition fee.
Though there were no significant differences among graduating classes, the data would be more reliably comparable if there was a consistent time in the students’ education that the questionnaire was distributed.
In retrospect, it would have been useful to gather more identifying information such as gender, age, and race/ethnicity and minority status. Significant differences have been found among these subgroups in larger studies in medical education.5,8,24 It may also be worthwhile to see if religious affiliation influences the lifestyle of students enough to show an association between religion and specialty choice.
Future Directions
Though the results of this study are limited to the study population, it can be considered a pilot study for a larger-scale study that will include various geographic regions, private and public schools, and schools that have grades versus those that are pass/ fail. Once an adequate study design is in place, the results could be taken to another level by concurrently administering a personality test to see if personality type is predictive of or correlated to postgraduate program selection.
This study was aimed mainly at traditional clinical specialties within dentistry; dental public health and nontraditional pathways such as health management, consulting, and government positions cannot be accurately assessed by the current design. Future studies may choose to exclude students who pursue such pathways or to analyze them separately.
In addition to the aforementioned ideas for inclusion in future studies, it may also be worthwhile to collect information on class rank or academic standing and the amount of personal debt as distinguished from educational debt, as well as if the participant has children; if the program is MATCH or non-MATCH; if the program pays versus charging tuition; if it offers the opportunity or requirement to teach; and if there are financial obligations to immediate or extended family members. It may also be worthwhile to know if this is a student’s first career or if he or she is returning to school in hopes of a career change. Furthermore, it needs to be clarified to the participants whether salary, benefits, predictable work hours, etc. refer to the residency training years or the expected lifestyle after training is completed.
|
Conclusion
|
|---|
This is the first study investigating the factors that influence dental students’ choice in field of study and postgraduate program selection. The findings of this study have implications for dental school administrators and postgraduate program directors who may wish to attract top applicants by altering certain aspects of a program or the interviewing process.
Furthermore, encouraging the ADA or other organizations to administer an annual questionnaire similar to the graduate questionnaire given to all graduating medical students in the United States would provide for a consistent way to track national and regional trends in postgraduate dental education. Delineation of factors that influence students’ choice of postgraduate programs may allow dental schools to enhance mentoring and counseling for their students about career pathways and help postgraduate education program directors attract the most suitably matched candidates for available positions.
|
Author Information
|
|---|
Dr. Saeed, a former D.M.D. Student, Harvard School of Dental Medicine, is currently in the General Practice Residency Program, University of California, San Francisco; Ms. Jimenez is a Doctoral Student and Research Fellow, Harvard School of Dental Medicine and Harvard School of Public Health; Dr. Howell is Professor of Periodontology and Dean of Dental Education, Harvard School of Dental Medicine; Dr. Karimbux is Associate Professor of Periodontology and Assistant Dean of Dental Education, Harvard School of Dental Medicine; and Dr. Sukotjo is Instructor, Department of Restorative and Biomaterial Sciences, Harvard School of Dental Medicine. Direct correspondence and requests for reprints to Dr. Cortino Sukotjo, Department of Restorative and Biomaterial Sciences, Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115; 617-432-0901 fax; cortino_sukotjo{at}hsdm.harvard.edu.
|
REFERENCES
|
|---|
- National GME census. American Medical Association, 2007. At: www.ama-assn.org/ama/pub/category/5671.html. Accessed: October 14, 2007.
- Medical school graduation questionnaire. Association of American Medical Colleges, 2007. At: www.aamc.org/data/gq. Accessed: October 14, 2007.
- Coffin SE, Babbot D. Early and final preferences for pediatrics as a specialty: a study of U.S. medical school graduates in 1983. Acad Med 1989; 64:600–5.[Medline]
- Spar IL, Pryor KC, Simon W. Effect of debt level on the residency preferences of graduating medical students. Acad Med 1993; 68:570–2.[Medline]
- Xu G, Rattner SL, Veloski JJ, Hojat M, Fields SK, Barzan-sky B. A national study of the factors influencing men and women physicians’ choices of primary care specialties. Acad Med 1995; 70:398–403.[Medline]
- 2004–2005 survey of predoctoral dental education: academic programs, enrollment, and graduates. Vol. 1. Chicago: American Dental Association, 2006.
- Chmar JE, Weaver RG, Valachovic RW. Annual ADEA survey of dental school seniors: 2005 graduating class. J Dent Educ 2006; 70(3):315–39.[Free Full Text]
- DiTomasso RA, DeLauro JP, Carter ST. Factors influencing program selection among family practice residents. J Med Educ 1983; 58:527–33.[Medline]
- Kassebaum DG, Szenas PL. Factors influencing the specialty choices of 1993 medical school graduates. Acad Med 1994; 69:163–70.[Medline]
- Lebovits A, Cottrell JE, Capuano C. The selection of a residency program: prospective anesthesiologists compared to others. Anesth Analg 1993; 77:313–7.[Medline]
- Simmonds AC, Robbins JM, Brinker MR, Rice JC, Kerstein MD. Factors important to students in selecting a residency program. Acad Med 1990; 65:640–3.[Medline]
- Sledge WH, Leaf PJ, Sacks MH. Applicants’ choice of a residency training program. Am J Psychiatry 1987; 144:501–3.[Abstract/Free Full Text]
- Bruner MK, Hilgers KK, Silveira AM, Butters JM. Graduate orthodontic education: the residents’ perspective. Am J Orthod Dentofacial Orthop 2005; 128:277–82.[Medline]
- Marciani RD, Smith TA, Heaton LJ. Applicants’ opinions about the selection process for oral and maxillofacial surgery programs. J Oral Maxillofac Surg 2003; 61:608–14.[Medline]
- Calnon WR. The residency pathway to dental licensure: the paradigm shift from inception to policy. J Evid Base Dent Pract 2006; 6:138–42.
- License requirements, dentistry. New York State Education Department, Office of the Professions, 2007. At: www.op.nysed.gov/dentlic.htm. Accessed: March 26, 2007.
- Burack JH, Irby DM, Carline JD, Ambrozy DM, Ellsbury KE, Stritter FT. A study of medical students’ specialty-choice pathways: trying on possible selves. Acad Med 1997; 72:534–41.[Medline]
- Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by U.S. medical students. JAMA 2003; 290:1173–8.[Abstract/Free Full Text]
- Fincher RE, Lewis LA, Rogers LQ. Classification model that predicts medical students’ choices of primary care or non-primary care specialties. Acad Med 1992; 67:324–7.[Medline]
- Greer T, Carline JD. Specialty choice by medical students: recent graduate follow-up survey at the University of Washington. Fam Med 1989; 21:127–31.[Medline]
- Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties. Arch Surg 2002; 137:259–67.[Abstract/Free Full Text]
- Schwartz RW, Haley JV, Williams C, Jarecky RK, Strodel WE, Young B, Griffen WO Jr. The controllable lifestyle factor and students’ attitudes about specialty selection. Acad Med 1990; 65:207–10.[Medline]
- Schwartz RW, Jarecky RK, Strodel WE, Haley JV, Young B, Griffen WO Jr. Controllable lifestyle: a new factor in career choice by medical students. Acad Med 1989; 64:606–9.[Medline]
- Lieu TA, Schroeder SA, Altman DF. Specialty choices at one medical school: recent trends and analysis of predictive factors. Acad Med 1989; 64:622–9.[Medline]
- Colquitt WL, Smith, IP, Killian CD. Specialty selection and success in obtaining choice of residency training among 1987 U.S. medical graduates by race-ethnicity and gender. Acad Med 1992; 67:660–71.[Medline]
This article has been cited by other articles:
|
|
|
|
 
M. A. da Fonseca and M. L. Stiers
Gender Preferences in the Choice of a Pediatric Dental Residency Program
J Dent Educ.,
September 1, 2009;
73(9):
1102 - 1106.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
Methods
