10.59987/ads/2018.1.27-34
Aim. At present, little research exists regarding factors that influence dental students and recent graduates to pursue specialist training. Through the provision of a questionnaire, the study investigated student’s perceptions of dental specialities and factors impacting specialisation.
Methods. Questionnaires (n=65) were undertaken by Doctor of Dental Medicine students in year three (n=34) and four (n=31) through paper means. An analysis was undertaken of the knowledge of speciality courses, speciality preferences and the main motivating and deterring factors influencing specialisation.
Results. A response rate of 70% was observed, revealing that 13% of all participants correctly identified the speciality courses available in Western Australia, with 6% of students wanting to specialise in the long term. Altruistic factors were most motivating and financial most deterring when considering specialisation. Speciality preferences also varied between cohorts.
Conclusions. Findings highlight that a small proportion of students want to pursue specialisation and the majority of students are unaware of the speciality courses available in Western Australia. This emphasises the need for greater exposure and education in dental specialties. Further research is advised in this field to better understand factors involved in the pathway to dental specialisation and how to encourage specialisation.
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Annali di stomatologia
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Factors influencing consideration of dental specialisation: a survey of current dental students at the University of Western Australia
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Factors influencing consideration of dental specialisation: a survey of current dental students at the University of Western Australia
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                                                                                                Original article



    Factors influencing consideration of dental
    specialisation: a survey of current dental students
    at the University of Western Australia




                                                                                              li
                                                                                            na
    Anthony Giummarra1 DMD                                 Conclusions. Findings highlight that a small pro-
    Keenan Inderjeeth1 DMD                                 portion of students want to pursue specialisation
    Dina Celebic1 DMD                                      and the majority of students are unaware of the




                                                                                          io
    Zi Lin Sun1 DMD                                        speciality courses available in Western Australia.
    Julio Cesar Rincon1 DMD                                This emphasises the need for greater exposure
    Iole Vozza DDS, PhD2                                   and education in dental specialties. Further re-




                                                                     az
    Alessandro Quaranta3 DDS, PhD                          search is advised in this field to better understand
                                                           factors involved in the pathway to dental speciali-
                                                           sation and how to encourage specialisation.
    1 Private practice, Research Program in Oral




                                                                   rn
    Implantology and Periodontics, Dental School,          Key words: dental, specialisation, factors, stu-
    The University of Western Australia,                   dents, survey questionnaire.
    Crawley, Australia
    2 Adjunct Professor, Dental School, Department of




                                                      te
    Oral and Maxillofacial Sciences, “Sapienza”            Introduction
    University of Rome, Rome, Italy
    3 Associate Professor, Dental School, The University   The dental workforce is an important healthcare re-
    of Western Australia, Crawley, Australia
                                                    In     source that allows dentists, through education, diag-
                                                           nosis and treatment, to provide the public with an
                                                           essential health service. There are over 15,000 den-
    Corresponding author:                                  tists in Australia, with 10% of those working as spe-
    Iole Vozza                                             cialist dentists (1). Dental specialists are trained as
                               ni

    Department of Oral and Maxillofacial Sciences          general practitioners in dentistry but have additional
    “Sapienza” University of Rome                          qualifications and experience within a chosen field.
    Via Caserta 6                                          In Australia, specialist education and training with
                             io


    00161 Rome, Italy                                      Australian Dental Council (ADC) accreditation is of-
    E-mail: iole.vozza@uniroma1.it                         fered in 12 specialities (2). Specialists play a key role
                                                           in maintaining clinical excellence and in providing
                           iz



                                                           leadership in dentistry. As such, the monitoring and
    Summary                                                surveillance of dental specialists is imperative as it
                                                           can provide information about specialist training and
           Ed




    Aim. At present, little research exists regarding      assist in improving the geographic reach of special-
    factors that influence dental students and recent      ists, especially in supporting primary care (3, 4) In or-
    graduates to pursue specialist training. Through       der to cater for the replacement of retiring specialist
    the provision of a questionnaire, the study investi-   dentists and population growth, adequate training
    gated student’s perceptions of dental specialities     programs aim to maintain the availability of specialist
    and factors impacting specialisation.                  dentists within Australia. Furthermore, there is a con-
 IC




    Methods. Questionnaires (n=65) were undertaken         tinuing need to ensure dental students are well-in-
    by Doctor of Dental Medicine students in year          formed and guided in their decision to pursue spe-
    three (n=34) and four (n=31) through paper             cialist training.
    means. An analysis was undertaken of the knowl-        At present, there is little research regarding the fac-
C




    edge of speciality courses, speciality preferences     tors that influence dental students and recent gradu-
    and the main motivating and deterring factors in-      ates to progress into specialist training pathways
    fluencing specialisation.                              and postgraduate dental study. A comprehensive re-
    Results. A response rate of 70% was observed,          view of the literature revealed that there were no
©




    revealing that 13% of all participants correctly       specific reports on Australian dental students or den-
    identified the speciality courses available in West-   tist’s perceptions of dental specialties. Several stud-
    ern Australia, with 6% of students wanting to spe-     ies have been conducted in the United States to ex-
    cialise in the long term. Altruistic factors were      plore the various reasons dental students chose to
    most motivating and financial most deterring           enter the profession and their subsequent career ex-
    when considering specialisation. Speciality pref-      pectations (5-10). Additional literature exploring
    erences also varied between cohorts.                   these factors has been published about dental stu-

    Annali di Stomatologia 2018;IX(1):27-34                                                                      27
    A. Giummarra et al.


    dents in the United Kingdom, Saudi Arabia, United             The survey instrument covered the following four ar-
    Arab Emirates, Thailand, Japan and Sweden (11-14).            eas: Demographics, Long-term career goals, Knowl-
    A small set of additional studies has investigated the        edge of specialty Fields, and Factors Affecting future
    perceptions of dental specialities, influencing factors       Specialisation. In the fourth section, Factors affect-
    on speciality choice and long-term career plans (15-          ing future specialisation, participants chose from a




                                                                                                    li
    20). The critical role of dental specialists presents the     list of factors known to influence pursuit of postgrad-
    need to explore these factors in an Australian con-           uate specialist studies and future career choices.




                                                                                                  na
    text as there is currently a gap in the literature.           Students rated the factors on a three point Likert
    The aim of this paper is to determine which factors           scale; motivating, deterring or neutral. The factors
    motivate and deter current dental students and re-            were grouped into four major categories: Financial,
    cent graduates (within the last two years) at the Uni-        Altruistic, Professional and Personal factors which
    versity of Western Australia (UWA) from pursuing              may influence their decision towards dental speciali-




                                                                                                io
    specialisation in the future. Findings from this re-          sation.
    search aim to provide specialists and course con-             All hard copy records are kept in a locked cupboard
    veners at the UWA Dental School with valuable infor-          at all times within academic staff offices at the UWA




                                                                            az
    mation to facilitate specialisation pathways. Further-        Dental School. It is only available to the research
    more, as it is the first study of its kind in Australia, it   team and will be retained for a minimum of 7 years.
    may serve as a pathway for future research regarding          All digital records are unidentifiable and kept on
    factors motivating postgraduate dental students and           UWA servers which are protected by user login per-




                                                                          rn
    newly qualified dentists to consider dental speciali-         missions.
    sation.                                                       All participants were given a clear option to opt in or
                                                                  out of the study. They were given a clear explanation
                                                                  of the research aim, objectives and how the data will




                                                           te
    Material and methods                                          be used. Consent forms were given to current stu-
                                                                  dents who chose to participate whilst the consent
    The study design was a cross sectional qualitative            forms were combined in the online survey for alumni
    study aimed at current students and recently gradu-
                                                         In       participants.
    ated alumni at the University of Western Australia.           Data analysis was undertaken to identify the moti-
    Human ethics approval from the University of West-            vating and deterring factors influencing considera-
    ern Australia was obtained prior to commencement              tion to specialise. As such, a combination of de-
                              ni
    of data collection (27/2/17: RA/4/1/8817). Two forms          scriptive and inferential statistics was utilised to as-
    of data collection were utilized; a voluntary anony-          certain knowledge of specialty courses, specialty
    mous paper questionnaire for the third (n=52) and             preferences and the main motivating and deterring
    fourth (n=41) year students of the Doctor of Dental
                            io

                                                                  factors influencing specialisation. a univariate
    Medicine (DMD) program, and an online question-               analysis was undertaken to present an overview of
    naire tool, Qualtrics®, for the two alumni classes of         findings from the study.
    2014 and 2015 (combined n=140). Initially, a single
                          iz



    trial survey was distributed to the Doctor of Clinical
    Dentistry (DCD) students to provide feedback re-              Results
    garding ambiguity and possible misinterpretation of
           Ed




    questions. Following this, the final, revised survey          The questionnaire was completed by 65 DMD stu-
    was distributed in June 2017, where third and fourth          dents out of a possible 93 dental students (52 DMD3
    year DMD students were approached after lectures              students and 41 DMD4 students). Though the total
    with a paper questionnaire to complete. Alumni were           response rate was 70% across DMD3 and DMD4,
    contacted with aid of the UWA Alumni Society, via             not all questionnaires were completed in full. Ques-
    email with a Qualtrics® survey link. This was neces-          tions which were answered incorrectly or left blank
 IC




    sary to protect the identities of participants. Both          were voided from the study. The survey had a 0% re-
    surveys were voluntary and anonymous. Our partici-            sponse rate from alumni.
    pants were chosen as a convenience sample, which
    allowed for a range of experiences regarding choic-           Demographics: The study sample consisted of 34
C




    es, preferences, and motivations to be investigated.          students from third year DMD (DMD3) and 31 stu-
    Through an analysis of current literature, examples of        dents from fourth year DMD (DMD4). Of the 65 stu-
    survey questions and survey formats were explored             dents, there were 32 males (49%) and 33 females
    and modified for use in this study. Analysis of ques-         (51%). The majority of participants were science
©




    tions for relevance were then shortlisted and fi-             graduates (n=55, 85%) and the prevalent age group
    nalised before being presented to the supervisor.             amongst participants was “20-24 years old” (n=30,
    The questions were modified and tailored to an Aus-           46%). The survey found that 54 out of the 65 partici-
    tralian audience, then grouped to increase statistical        pants (83%) had previously obtained a bachelor de-
    significance of results.                                      gree as their high level of education (Tab. 1).



    28                                                                                Annali di Stomatologia 2018;IX(1):27-34
    Factors influencing consideration of dental specialisation: a survey of current dental students at the University of Western
    Australia

    Table 1 - Demographics Table.                                    Long term career goals: The number of respondents
                                                                     who indicated that they wanted to specialise long
    Class Year       DMD3                 34                         term was 6% (n=4). Additionally, the survey revealed
                     DMD4                 31                         five participants were considering applying to a post-
                                                                     graduate specialty course. The survey found that




                                                                                                         li
                                                                     42% participants (n=27) showed a long-term career
    Gender           Male                 32                         goal of becoming a general dentist while 52% (n=34)




                                                                                                       na
                     Female               33                         showed a long-term career goal of being a general
                                                                     dentist with a specialty interest (Fig. 1).

    Previous         Science                                         Knowledge of specialty courses: The survey found
    Degree           Non-Science          55                         that 51% of respondents (n=33) believed that they




                                                                                                     io
                                          10                         were aware of current specialisation courses of-
                                                                     fered in Western Australia. In addition, 45% (n=29)
    Age Group        20-24 years          30
                                                                     stated they were somewhat aware whilst 3% of stu-




                                                                                az
                     25-29 years          27                         dents (n=2) were not aware of the courses avail-
                     30-34 years          5                          able. The results demonstrated that 84% of respon-
                     35+ years            3                          dents (n=56) were incorrect when asked to identify
                                                                     what specialty courses are currently available in




                                                                              rn
                                                                     Western Australia, with only 13% (n=9) correctly re-
    Marital          Single               42                         sponding. Two surveys had incomplete responses
    Status           Married              4                          for this section and thus they were voided from the
                                                                     results (Fig. 2).




                                                           te
                     Non-Married          19
                                                                     Furthermore, the number of students who had dis-
                     Other                0
                                                                     cussed a speciality interest with their mentor, super-
                                                                     visor or specialist varied between the dental student
    Education        Bachelor             54
                                                         In          cohorts with 80% of DMD3 students and 19% of
    Attained         Honours              9                          DMD4 students stating they had enquired about spe-
                                                                     cialisation.
                     Masters              0
                                                                     Specialty preferences: The specialty preferences var-
                                 ni
                     Doctorate            0
                     PhD                  2                          ied between DMD3 and DMD4 as per Figure 3 and
                                                                     Figure 4. Orthodontics was the most preferred spe-
                                                                     cialty (24%) in DMD3 whilst Oral and Maxillofacial
                               io


    Location         WA                   34             50          Surgery was the most preferred specialty (29%)
                     Interstate           Metropolitan   7           amongst DMD4. No students in either cohort had se-
                                                                     lected Oral Pathology and Radiology as their most
                             iz



                     International        23 Rural       8
                                                                     preferred specialty.
              Ed




                                                                                                          Figure 1. Long term
                                                                                                          career goals.
 IC
C
©




    Annali di Stomatologia 2018;IX(1):27-34                                                                                   29
    A. Giummarra et al.


                                                                                                     Figure 2. Knowledge
                                                                                                     of specialty courses
                                                                                                     available in UWA.




                                                                                                    li
                                                                                                  na
                                                                                                io
                                                                           az
                                                                         rn
                                                          te
                                                        In
                              ni
                            io
                          iz
           Ed
 IC




    Figure 3. DMD3 Specialisation preferences.
C




    Factors influencing future specialisation: The factors in-   (n=172 out of 384 responses) or motivating (n=201 out
    fluencing specialisation were grouped into the follow-       of 384 responses). Personal factors had most respons-
    ing four groups: Professional, Financial, Altruistic and     es as neutral (n=224 out of 384 responses). Overall, the
    Personal Factors. These were charted on a Likert scale       factors which the most number of participants found to
©




    of motivating, deterring or neutral (Fig. 5). Professional   be deterring were financial whilst the factors found to
    factors were found to be either neutral (n=171 out of        be the most motivating were altruistic factors. The
    384 responses) or motivating (n=166 out of 384 re-           question which was the most deterring factor amongst
    sponses) amongst the sample group. Financial factors         students was the “financial impact of returning to
    were found to be predominantly neutral when influenc-        study” whilst the question determined to be the most
    ing specialisation (n=169 out of 384 responses) whilst       motivating factor was the altruistic factor of “providing
    altruism related factors were predominantly neutral          a service to the community”.

    30                                                                                Annali di Stomatologia 2018;IX(1):27-34
    Factors influencing consideration of dental specialisation: a survey of current dental students at the University of Western
    Australia




                                                                                                         li
                                                                                                       na
                                                                                                     io
                                                                                az
                                                                              rn
                                                             te
    Figure 4. DMD4 Specialisation preferences.             In
                               ni
                             io
                           iz
           Ed
 IC
C




    Figure 5. Factors influencing future specialization.



    Discussion                                                       tors which motivated these students is important in
©




                                                                     understanding student’s pathways to specialisation.
    Long-term career goals                                           As only a small number of participants in this survey
    The number of students who indicated that they                   had a view to specialise, this limits any significant
    had a long-term goal to specialise was only 6% of                analysis of factors which may have influenced their
    respondents (n=4) whilst five participants (8%) stat-            decision to consider specialisation. Nevertheless,
    ed they had an interest in applying to a Doctor of               the proportion of our sample group that indicated a
    Clinical Dentistry (DCD) course. Analysing the fac-              desire to specialise was found to be comparable

    Annali di Stomatologia 2018;IX(1):27-34                                                                                   31
    A. Giummarra et al.


    with the current specialist workforce within Australia.    Specialty preferences
    There are over 15 000 dentists in Australia with 10%       Specialty preferences differed between third and
    of those working as a specialist dentist (1).              fourth year DMD students. Oral and Maxillofacial
    Thirty-four participants (52%) indicated they had a        surgery was the most popular specialty chosen by
    long-term career goal of becoming a general practi-        DMD (n=8, 29%), whereas DMD3 students ranked




                                                                                                  li
    tioner with a specialty interest. Therefore, there ap-     Orthodontics as their most preferred specialty (n=5,
    pears to be an interest within our sample group to-        24%) (Figs. 3, 4). This was consistent with existing




                                                                                                na
    wards speciality practice. The factors which moti-         literature which found that Oral and Maxillofacial
    vate or deter students to pursue dental specialisa-        Surgery and Orthodontics as the most common spe-
    tion are especially pertinent to this group. As the        cialties favoured by dental students (11-14, 22). Fur-
    survey has shown they have an interest in specialty        thermore, literature indicates that both Orthodontics
    practices and may choose to undertake specialisa-          and Oral and Maxillofacial surgery are the most com-




                                                                                              io
    tion training in the future given the appropriate cir-     mon dental specialities throughout the world (23).
    cumstances. Existing literature which examined the         Differences in specialty preference may be influ-
    proportion of dental students who wish to spe-             enced by the structure of the DMD course and both




                                                                         az
    cialise are varying in their results. In contrast to the   the timing and amount of exposure of each specialty
    results of this study, studies performed in United         during the course. At UWA Dental School, oral
    Arab Emirates and Iran found a high preference for         surgery rotations are introduced in third year howev-
    specialisation around 92% (13). A study at a Lon-          er, it is not until final year where students gain sub-




                                                                       rn
    don Dental School showed that 50% of respon-               stantial exposure to minor oral surgery procedures
    dents wished to extend and refine their skills to          such as extractions. Furthermore, there are no ortho-
    train as a dentist with a special interest, or as a        dontic rotations in fourth year, which may be corre-




                                                        te
    dental specialist. Of this group, 25% wished to be-        lated to the decline in interest observed for Ortho-
    come specialists and 27% were interested in gener-         dontics when compared to the third year prefer-
    al practice with a specialty interest (21). The pro-       ences. In both year groups, no students selected Ra-
    portion of students in our study who have an inten-        diology as a specialty as their first preference for
                                                      In
    tion to specialise is reduced relative to the existing     specialisation and only 7% of final year DMD stu-
    literature.                                                dents indicated that they would consider Special
                                                               Needs dentistry. One possible reason for the low in-
    Knowledge of specialty programs                            terest in Special Needs and Radiology is due to the
                              ni
    Most DMD students were not correctly aware of cur-         lack of exposure during the DMD course when com-
    rent specialty courses available in Western Australia.     pared to other specialties. Additionally, these two spe-
    Nine students (13%) were correctly aware of the spe-       cialties are also not offered in Western Australia though
                            io


    ciality pathways available in Western Australia whilst     they are offered at the University of Sydney (Special
    the remaining students incorrectly believed that they      Care Dentistry) and University of Queensland (Special
    were aware (n=33, 51%) or “somewhat aware”                 Needs and Dento-Maxillofacial Radiology).
                          iz



    (n=29, 44%). It is evident that students may be ill-in-
    formed or unaware about what specialisation cours-         Factors influencing future specialisation
    es are available and thus, students who are not            The survey found that the most motivating factors
           Ed




    aware of specialisation pathways are less likely to        were Altruistic factors when students considered
    specialise. This reveals a key area in which dental        specialisation. When compared with the other cate-
    schools can improve interest. Course convenors can         gories of Professional, Financial and Personal, Altru-
    use this opportunity to raise awareness of the spe-        istic factors were found to be the most motivating,
    cialty programs available and to stimulate interest for    especially the aspect of “providing a service to the
    students. The low number of correct responses              community”. Studies from the United States and
 IC




    about the specialty programs offered in Western            United Kingdom have shown similar results where
    Australia is correlated with less than half of students    the enjoyment of providing specialist care was the
    (47%, n=26) discussing specialisation with a mentor,       most important factor in pursuing specialist training
    supervisor or specialist. Additionally, the proportion     or career choices. Other factors found to be impor-
C




    of students in DMD4 who had discussed with a men-          tant by other studies in long-term career pathways
    tor, supervisor or specialists was much less than          include “work life balance”, “high income/financial
    those in DMD3. This may be attributed to the infancy       security”, “professional development”, “enjoyment of
    of the DMD course at UWA, with current DMD4 stu-           providing care in that field”, “influence of family
©




    dents being the second cohort to enter the program,        members in the dental profession” (8, 11, 21, 24, 25).
    potentially less emphasis has been placed on garner-       The most deterring factors for specialisation were
    ing student interest and informing awareness of den-       those within the Financial category, with the most
    tal specialties. Nevertheless, a target to improve spe-    deterring factor identified to be the “financial impact
    cialisation awareness would be implemented through         of returning to full time study”. The second most de-
    greater discussion between students and academic           terring factor, “cost of specialty course” further rein-
    staff to inform and facilitate interest.                   forces the negative impact of Financial factors on the

    32                                                                              Annali di Stomatologia 2018;IX(1):27-34
    Factors influencing consideration of dental specialisation: a survey of current dental students at the University of Western
    Australia

    pursuit of specialisation. These findings are consis-            Conflict of interest
    tent with existing literature, where financial aspects
    have been found to negatively impact specialisation.             The Authors declare no conflict of interest.
    The postgraduate nature of the DMD program at
    UWA may have impact on the priorities and prefer-




                                                                                                               li
    ences of the participants of this study, as further              References
    study may place a large financial burden.




                                                                                                             na
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                                                                                                           io
                                                                     3.    Gallagher J, Wilson N. The future dental workforce? Br Dent
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                                                                                 az
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                                                                               rn
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                                                           te
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                                                                     9.    Zarchy M, Kinnunen T, Chang BM, et al. Increasing pre-
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                             io


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                           iz



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           Ed




                                                                     12.   Mitrakul K, Asvanund P, Kitisubkanchana J. Dental gradu-
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                                                                           in Japan and Sweden. Eur J Dent Educ. 2009 May;13(2):80-
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    cialisation, with the majority of students not aware of          15.   Da Fonseca MA, Pollock M, Majewski R, et al. Factors in-
C




    the specialty courses available in WA. The study em-                   fluencing candidates’ choice of a pediatric dental residency
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©




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