|Year : 2014 | Volume
| Issue : 2 | Page : 113-118
Factors influencing dental professional career in India: An exploratory survey
Shivam Kapoor, Manjunath P Puranik, SR Uma
Departments of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
|Date of Web Publication||6-Sep-2014|
Department of Public Health Dentistry, Government Dental College and Research Institute, Fort, Victoria Hospital Campus, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Motives for choosing a career are complex, and a choice of dentistry as a career is no exception. It is expected that the person should have some expectations in terms of their future, and the fulfillment of these expectations should give some amount of satisfaction. Aim: The aim was to explore factors influencing dental professional career: Attitudes, perceptions, and motivations. Materials and Methods: A cross-sectional survey was carried out in May and June 2013, among 445 interns working in the dental colleges of Bangalore using a self-administered validated questionnaire. The data were analyzed using SPSS version 18. Descriptive statistics, independent t-test, ANOVA and Pearson's correlation test were used (P < 0.05). Results: The most popular reason for choosing dentistry as a career was to serve people (81.3%). Majority of them enjoyed helping people (92.8%); appeared to be satisfied with their doctor-patient relationship (92.4%); appreciated the independence in the profession (92.1%); aspired to enhance clinical skills (94.2%) and realized the importance of higher education (87%) in the future. Private practice (81.4%) was the most preferred future career plan. Attitudes and perceptions significantly correlated with future career plans (P < 0.05). Conclusion: Service to mankind coupled with autonomy, self-efficacy and inclination to excel in one's own field appeared to influence dental careers in India.
Keywords: Attitude, career choice, dental education, perception, professional, India
|How to cite this article:|
Kapoor S, Puranik MP, Uma S R. Factors influencing dental professional career in India: An exploratory survey. J Indian Assoc Public Health Dent 2014;12:113-8
|How to cite this URL:|
Kapoor S, Puranik MP, Uma S R. Factors influencing dental professional career in India: An exploratory survey. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Aug 19];12:113-8. Available from: http://www.jiaphd.org/text.asp?2014/12/2/113/140278
| Introduction|| |
Dental surgeons occupy an important position in society as licensed health care professionals, but this doesn't come without challenges.  It is expected that in choosing a career, the person should have some expectations in terms of their future, and the fulfillment of these expectations should give some amount of satisfaction.  The choice of a dental career is motivated beyond doubt by the financial and social status of the profession , while some dental students are primarily driven by a desire for varied work, opportunity to put theory into practice, altruistic motivations regarding helping people and improving their appearance. ,,,,
In India, students enter dental education following nationwide or statewide competitive entrance examinations. Parental pressure is another factor that plays a role in students' choice of dentistry as a career.  Regardless of their reason for choosing dentistry as a career, the expectation of a secure and bright professional future is what keeps most students motivated during the course of their dental education.  Apart from this, several other factors such as the academic environment and the dental curriculum also influence students' attitudes.
The professional socialization begins with admission to the dental school and continues through the entire study period of the student.  However, the peak of socialization is seen during the period of internship. By now the students are expected to have a firm theoretical background which is gelled within their clinical skills. Compared to the other dental students/cohorts, the interns are at a crossroads with numerous options and uncertainties. Thus at this stage, it is very important to understand students' motives for choosing dentistry and their views concerning the future of their profession so as to preserve a motivated workforce. 
Globally a majority of studies ,,,,,,,,,,,, have explored the motivations of dental students for choosing dentistry, and only a few ,,,, have related these choices with the future. Moreover, such evidence is scant in India. , Hence, the present study was undertaken amongst dental interns in Bangalore.
To explore the factors influencing dental professional career using a validated tool.
• To assess interns' attitudes and perceptions toward dental profession and future plans
• To correlate interns' attitudes, perceptions and motivations with future career plans.
| Materials and Methods|| |
An exploratory study with a cross-sectional design was conducted among 445 interns working in dental colleges of Bangalore. The study was conducted in two phases (survey tool development and data collection) for the duration of 2 months (May and June 2013). Prior permission was obtained from the head of the institutions of all the dental colleges. Ethical clearance was obtained from the Institutional Review Board.
Survey tool development
A thorough literature search was done, and questions were selected from previous studies. ,,, Apart from that, with the help of a focus group (a team of five interns), new items were added. A preliminary 80-item questionnaire was thus developed and screened for face validity. Six items were eliminated. A consultative committee consisting of a Psychiatrist, a Statistician, and three specialists in Public Health Dentistry carried out the content validation of the 74-item questionnaire using Lawshe approach.  In this, the experts were asked to rate the questions either as: Essential/not essential but important/neither essential nor important. The questions considered essential were further rated on a scale of 1-10 and analyzed using Aiken V index. An item with a value of V > 0.7 indicated a high degree of agreement among experts and hence was considered for inclusion in this study. 
This resulted in a 53-item questionnaire, which was a pilot tested for reliability on a sample of twenty dental interns (test-retest reliability α = 0.825); further split-half reliability was also assessed by arranging the questions in odd-even order (Cronbach's α = 0.724). Internal consistency was assessed using inter-item correlation.
The list of the dental colleges was obtained from Rajiv Gandhi University and Health Sciences website (www.rguhs.ac.in).  There are 16 dental colleges in Bangalore, including one government college wherein students across the country pursue dentistry. Admissions to these colleges are through various competitive examinations. In the present study, all the dental colleges were included. Dental interns present on the day of the study, and those who gave consent were included; there were no exclusion criteria since the sampling method was based on census.  Self-administered questionnaire forms were distributed to the interns after informing about the nature of the study, and confidentiality was assured. On average, each intern took about 15 min to complete the form. The forms were then collected and scrutinized for completeness on the day of the study.
Demographic information such as age, gender, marital status and educational institution was collected. In addition to this, socioeconomic status was assessed using Kuppuswamy's scale (parent's education, occupation and family income)  the questionnaire comprised of a pretested survey tool with 53-item on a 5 point Likert-scale grouped into four sections.
First section explored items (7) that could have influenced their choice of dentistry as a career. The second section consisted of 19 items on their attitudes and perceptions (7: General and 12: Personal) about the aspects of the dental profession. The third section assessed interns' perceptions on the present dental curriculum using 10 items. The last section determined interns' motivation (12-item) and opinions (5-item) regarding future career plans.
The statistical analyses were done using the IBM corporation, SPSS Inc. Chicago, IL, USA version 18 software package. Descriptive and inferential statistics were computed. A P < 0.05 was considered to be statistically significant. The 5-point Likert scale was made to a 3 point scale for the ease of the analysis. Strongly agree and agree were considered as agreement; while strongly disagree and disagree as disagreement.
The responses according to gender and marital status were tested for a significant difference using an independent t-test. Similarly, ANOVA was performed to test significant differences with respect to socio-economic status. Pearson's correlation test was used to correlate interns' attitudes and perceptions with their future career plans.
| Results|| |
Out of the 445 dental interns, 71.9% were females, and 93.3% were single [Table 1]. The mean age of the respondents was 23.47 ± 1.5 years (21-38 years); (median/mode = 23 years). Interest to serve the people, prestige and social status of the profession and family/friend's advice emerged as the most influencing factors on choosing dentistry as a career [Figure 1].
|Table 1: Distribution of dental interns according to sociodemographic variables (n=445) |
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|Figure 1: Influences on choice of dentistry among dental interns (n = 445)|
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In assessing interns' attitudes, perceptions and personal experiences towards the dental profession: "I am satisfied with my doctor-patient relationship abilities" gained the highest agreement (92.4%), whereas "I do not see enough abilities in myself to treat the patients" was least appreciated (17.8%). Majority of them enjoyed helping and improving appearance of people (92.8%); acknowledged the independence in the profession (92.1%) and were confident in doing dental treatment (91.4%). However, the study participants expressed their discontentment about the current dental curriculum as: "Tedious working hours and busy schedule" (71.7%), "stressful profession" (66.7%), "too long course duration" (62%).
Regarding the motivations toward future career plans, most of the respondents were inclined to enhance their clinical skills (94.2%) and realized the importance of higher education in India (87%) [Table 2]. Having a private practice appeared to be the choice of the majority whereas pursuing research projects after graduation hardly attracted half of the future dental workforce [Figure 2]. No statistically significant difference was found between the four sections and gender, socioeconomic status and marital status.
|Table 2: Dental intern's motivations toward future career plans (n=445) |
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|Figure 2: Opinions of dental interns regarding future career plans (n = 445)|
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Overall, a weak correlation was observed between all the four sections and the future career plans. Working at dental clinic, private practice and entering specialty program abroad significantly correlated with section 1 (influences on choosing dentistry), section 2 (professional aspects of dentistry) and section 4 (motivations toward future career plans) (P < 0.05). Entering specialty program in the country significantly correlated with section 2 (professional aspects of dentistry) and section 4 (motivations toward future career plans) (P < 0.05). Taking a future research project significantly correlated with section 4 (motivations toward future career plans) (P < 0.05) [Table 3].
|Table 3: Correlation between responses to various sections and future career plans |
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| Discussion|| |
The goal of an undergraduate course in dentistry is to train students to become ethical, skilled professionals capable of practicing dentistry on a level that is consistent with the expectations of society. Understanding the students' motives for choosing dentistry as a career may aid recruiters in designing appropriate and effective recruitment materials. This may also help in providing students with a complete and accurate picture of the profession.
In the present study, the age of the respondents ranged from 21 to 38 years, with a mean age of 23.47 ± 1.5 years, mode of 23 years. This is comparable to final year United Arab students (21-29 years), with a mean of 23.8 and mode of 23 years.  A similar age cohort emerged in the UK study (22-33 years, with a mode of 23 years).  While our findings relatively differed from a previously reported Indian study: 18-25 years with a mean age of 20.50 ± 1.72 years. 
Our study showed female predominance, which reflects feminization of dentistry in India. This is similar to the previously reported study among Indian students (73.7% females).  Other authors have also reported predominance of female students in their study. ,,,,,,, Our results, however, contrasted with the dental students in Las Vegas (predominantly men [68.4%]),  US (females 40.5%)  and the African and White Americans (females 39.7%). 
There was no statistically significant difference between the four sections and gender, socioeconomic status and marital status; probably indicating that these variables did not influence the response of the participants.
The most important factors influencing the choice of dentistry were altruistic motive (to serve the people) along with prestige and social status. Altruistic motives also served as an influential factor among 81.3% of Iranian  and 44% of Swedish students.  Our results are also consistent with the Iranian,  Nigerian  and Jordanian  study where prestige and social status emerged out as the most influential factor.
In India, most students live with their families, and their parents play an important role in making decisions in the students' lives. This trend sometimes questions the independence exercised by individuals in choosing a profession that may determine the future course of their lives.  Two-thirds of the interns in our study chose family/friend's advice as an influential factor. While a similar opinion was expressed by a higher proportion (97.7%) of a comparable Indian cohort (Punjab and Haryana).  This finding is similar to study in Iran,  Nigeria,  Japan,  Canada  and U.A.E. 
Overall, the interns showed positive attitudes towards the profession. It would seem that these favorable perceptions would ensure the continuous development of dentistry in the next decades. Although the dental interns in our study opined dentistry as a stressful profession due to long course duration, tedious working hours and fear of patient satisfaction; this did not instill a negative attitude nor influenced their future career plans. They remained confident doing dental treatment and realizing their doctor-patient relationship. These findings are consistent Baharvand's study of Iranian students. 
As far as the future career plan is concerned, the majority intended to either start their private practice or work at a dental clinic similar to the Iranian study.  Whereas pursuing research was favored by 45.4% of the respondents. Swedish dental students relatively aspired more to become researchers when compared to Japanese (4.7% vs. 1.8%).  None of the Canadian (0.0%), some of the Japanese (1.6%) and Thai (3.3%) students wanted to be a researcher in their future.  On the contrary, majority of the respondents in the Iranian study were not sure (42.9%).  However, uncertainties about the future prospects maybe observed in the responses spread over the five areas of interest.
Overall, a weak correlation was observed between all the four sections and the future career plans. Working in dental clinic, private practice, entering specialty program abroad correlated with all the sections except section 3 (perceptions toward curriculum). Hence, it may be reasonably surmised that varied influences on career choice, perceptions and experience during the course will have a significant impact on the oral health in India. Hence, this study has implications for the admission of students to dentistry, their parents, professionalization, institutions, policy makers and professional leaders to understand the motives of the new dentists.
To the best of our knowledge, there is no previous data available depicting the predicament of dental interns in India. The study participants from all the colleges in Bangalore were recruited, thus representing various culture, language and regions across the country. Hence, the results may be extrapolated to the national level. A new research tool was developed after testing for validity and reliability. Since, the internal consistency (Cronbach's α) is well above the recommended 0.7 threshold,  it will, therefore, be a valuable tool for further research in India. Hence, this study contributes substantially to the existing body of knowledge and opens vistas for further research. Further studies may be augmented by a qualitative approach (involving focus group of students and professional leaders) to provide greater insight of the motivating factors and opinions regarding the present dental curriculum. A multicentric study in India which will provide a more representative group of interns should be carried out further.
However, there were some limitations to this study. Notably, the self-reported nature of the data (social desirability) could have resulted in information bias. Attitudes and perceptions change over time, subject to opportunities and interests. Hence, periodic as well as long-term surveys are required to capture the dynamic nature of attitudes and perceptions.
| Conclusion|| |
Overall the interns in the present study exhibited positive attitudes and perceptions towards their future career. This is reflected in influences on choosing dentistry; perceptions, experiences and motivations toward the future career. Service to mankind coupled with autonomy, self-efficacy and inclination to excel in one's own field appeared to influence dental careers in India.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]