|Year : 2017 | Volume
| Issue : 3 | Page : 234-238
Quantification of relative difficulty of public health dentistry and qualitative analysis of students' perspectives
Viswa Chaitanya Chandu, V Viswanath, Ajit Kumar Dabbiru, Vydehi Mullapudi, Srinivas Pachava
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Dr. NTR University of Health Sciences, Guntur, Andhra Pradesh, India
|Date of Web Publication||18-Sep-2017|
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Dr. NTR University of Health Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: The impression Public Health Dentistry (PHD) has created on the undergraduate dental students, which is evident from the disinterest shown toward the specialty in pursuing postgraduation is disheartening. Aim: The aim of this study is to quantify the relative difficulty of PHD compared to all other subjects in the final year undergraduate dental curriculum and to qualitatively analyze different aspects relating to the subject from students' perspective. Materials and Methods: This cross-sectional study involved collection of secondary data in the form of final year mark lists obtained from Dr. NTR University of Health Sciences' website. Mark lists of students appeared for final BDS examinations during February-March, 2016 and August 2016 were available and included in the study. The quantitative analysis was followed by administration of a semi-structured questionnaire to 246 house surgeons from three dental institutions in the state of Andhra Pradesh. Subject Pairs Analysis (SPA) was performed to quantify the relative difficulty of PHD, while Mann–Whitney U-test and Chi-square tests were performed to check the differences in relative difficulty scores, students' attitudes, respectively, based on student's gender, type of college, and availability of postgraduation in PHD in the respective colleges. Results: SPA revealed that only orthodontics and pedodontics were relatively easier compared to PHD, while all other subjects in the final year curriculum were relatively difficult. However, contrary to the quantitative results obtained, PHD was reported as the most difficult subject by 31% of the study participants. Differences were due to gender and availability of postgraduation in the specialty. Conclusion: There is a need to adopt new strategies in making the subject more interesting and understandable for students.
Keywords: Dental education, dentistry, public health, qualitative research
|How to cite this article:|
Chandu VC, Viswanath V, Dabbiru AK, Mullapudi V, Pachava S. Quantification of relative difficulty of public health dentistry and qualitative analysis of students' perspectives. J Indian Assoc Public Health Dent 2017;15:234-8
|How to cite this URL:|
Chandu VC, Viswanath V, Dabbiru AK, Mullapudi V, Pachava S. Quantification of relative difficulty of public health dentistry and qualitative analysis of students' perspectives. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Feb 24];15:234-8. Available from: http://www.jiaphd.org/text.asp?2017/15/3/234/215066
| Introduction|| |
The specialty of preventive and social dentistry was first started in the late 1960s by Dr. Mohandas Bhat at Government Dental College, Bangalore. Since then, the specialty has assumed various names and is now being referred to as Public Health Dentistry (PHD). Improvement in the oral health status of the entire Indian populace has always been at the heart of PHD. Although remained as a solitary comprehensive survey, the National Oral Health Survey and Fluoride Mapping 2002–2003 provided an invaluable picture of the burden of oral diseases in the nation and the contribution this survey has received from the specialty of PHD cannot be overstated. The Departments of PHD in various dental institutions across the nation have been conducting thousands of outreach programs to negotiate the notorious barriers of affordability and accessibility to dental care for disadvantaged populations. Since the Dental Council of India has made it mandatory for every dental institution to have satellite clinics, this responsibility has been delegated to the departments of PHD supporting rural outreach programs.
Although the aforementioned initiatives taken and the responsibilities delegated are laudable, a great majority of dental institutions have inadvertently adopted the concept that patients have to be treated in specialized departments, and the specialty of PHD is being viewed as a referring body. This ideology contradicts the reason for the inception of this specialty and does not contribute to improvement in the country's oral health status as desired. Furthermore, an unwanted liability is the instillation of this ideology among dental students which has obvious grave consequences for PHD as a specialty in the near future. Studies, highlight that PHD is among the least preferred specialties to pursue postgraduation. The reasons for this relatively low preferences compared to other specialties remain unexplored to a considerable extent. Some of the reasons for the aforementioned findings could be that the subject of PHD could be relatively difficult compared to other specialties or the students could be apprehensive about the career prospects for PHD or the students might not have been equipped with a lucid understanding of what a Public Health Dentist specializes in. With this background, the aim of this study is to quantify the relative difficulty of PHD compared to all other subjects in the final year dental curriculum of students and to qualitatively analyze the attitudes towards PHD among house surgeons in Andhra Pradesh.
| Materials and Methods|| |
This cross-sectional study involved collection and analysis of secondary data followed by exploration of students' perceptions on PHD using a semi-structured self-administered questionnaire. The study was conducted between August and September 2016. Ethical approval for the study was obtained from the institutional review board, and all the participants signed an informed consent before attempting the questionnaire.
Academic performance of students in dental institutions affiliated to Dr. NTR University of Health Sciences was chosen to quantify the relative difficulty of PHD compared to all other subjects in the final year curriculum. There are 25 dental institutions in the states of Andhra Pradesh and Telangana affiliated to the university with an intake of around 2330 students per year. Initially, an attempt has been made to collect the final year mark lists followed by personal interviewing of a subsample of students using a semi-structured questionnaire. However, minuscule response rate demanded alternative methods for obtaining data, and the website of Dr. NTR University of Health Sciences was resorted to. Secondary data were obtained in the form of mark lists of students appeared for Final BDS examination in February-March 2016 and August 2016 from the website.,
To quantify the relative difficulty of PHD, marks obtained in every individual subject in the final year curriculum are necessary. However, the university website does not provide details on marks obtained in those subjects where the student had either already passed or failed. For this reason, students who had either already passed or failed in one or more subjects were excluded from the analysis. A total of 1607 mark lists satisfying the study requisites were obtained from the university website.
The data were analyzed for quantification of relative difficulty of PHD using Subject Pairs Analysis (SPA). The first step in SPA was to convert the percentage of marks obtained in each subject into a numerical scale using consecutive nonzero positive integer values. The raw percentage of marks obtained in all the subjects was converted into grades by equal interval grading using an interval of 5 marks. The conversion resulted in six grades, from Grade 1 to Grade 6 with higher grade suggestive of better performance.
The second step in SPA was to calculate the grade differences between subject pairs with PHD as the reference subject in each of these pairs. Mean grade difference for each subject pair was determined by averaging the differences obtained in grades between the two subjects in the pair. This gives the relative difficulty of PHD compared to each other subject. The average of all these relative difficulties compared to all other subjects gives the overall relative difficulty of PHD. The analysis was performed both with overall marks and marks obtained in theory exclusively, to accommodate for plausible variations in the practical marks awarded to students between specialties.
A semi-structured questionnaire was administered to 246 house surgeons from three dental institutions affiliated to Dr. NTR University of Health Sciences who appeared for and cleared Final BDS examinations held in February-March, 2016 and August 2016 to identify the attitudes of the students toward the specialty of PHD. This criterion for inclusion was adopted to qualify for comparison with quantitative analysis which was done on students appeared for Final BDS examinations in the aforementioned academic years. The initial section of the questionnaire comprised a five-point semantic differential scale to elicit the attitudes of the students regarding the nature of specialty with respect to its difficulty, interestingness, and clinical integration. The subsequent questions were open-ended seeking information on the student's understanding of what a Public Health Dentist specializes in, career prospects for Public Health Dentists, and reasons for perceived difficulty. Anonymity was guaranteed to ensure untampered responses with honesty and accuracy. Of the 246 questionnaires administered, 192 filled questionnaires were returned and were checked for legible handwriting and mutually exclusive nature of responses for the items on semantic differential scale. Four filled questionnaires were excluded from analysis on the grounds of not satisfying the aforementioned criteria. All the 188 questionnaires qualified for analysis were subjected to open coding by a single investigator. Responses for items on semantic differential scale were dichotomized by omitting those responses where the middle point was chosen. Responses in text were labeled with codes as necessary. Constant comparative analyses were performed to ensure consistency in the coding process. The coding process was deemed complete after repeated comparison yielded no new categories.
Microsoft Excel and SPSS version 20 software (IBM SPSS statistics for Windows version 20, Armonk, NY, USA) were used to analyze the data. Mann–Whitney U-test was done to compare the differences in overall relative difficulty scores based on gender, type of college (government/private), and availability of postgraduation in PHD in the college. Chi-square test was done to compare the differences in attitudes of the students toward the specialty based on the aforementioned independent variables.
| Results|| |
Of the 1607 mark lists subjected for analysis, 1198 (74.54%) belonged to female students. SPA revealed that only the subjects of orthodontics and pedodontics were relatively easier compared to PHD, whereas all other subjects in the final year curriculum were relatively difficult. Quantifying the relative difficulty in absolute terms, the overall relative difficulty score for PHD when overall marks were considered was 0.2053, suggesting that the average score obtained in PHD was 0.2 grades higher than that obtained in other subjects. The overall relative difficulty score when theory marks were considered exclusively was 0.186. There were significant differences between males and females in the overall relative difficulty scores for PHD, with males obtaining considerably higher scores than females in PHD. No significant differences were found in scores based on the type of college. The students from those institutions where postgraduation in the specialty of PHD was available obtained higher grades, but the difference was only partially significant [Table 1].
|Table 1: Differences in overall relative difficulty score in Public Health Dentistry based on gender, type of college, and availability of postgraduation in Public Health Dentistry|
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Sixty-eight percent of the study participants opined that PHD is a nonclinical specialty, and slightly >3 quarters found the subject difficult. Nearly 71% opined that the subject is boring. PHD was reported as the most difficult subject by 31% of the study participants which is only next to Prosthodontics that was rated as the most difficult by 37%. Significant differences were found between males and females with regards to their perceived difficulty in the subject and interest. Students from those institutions with postgraduation in PHD were significantly different from their counterparts in their responses relating to the nature (clinical/nonclinical) of the specialty [Table 2].
|Table 2: Differences in student's attitudes based on gender, type of college, and availability of postgraduation in Public Health Dentistry|
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“Academics” was the exclusive answer given by the students for the question on career prospects for public health dentists. Most common response for the question on what a Public Health Dentist specializes in was organizing camps. Different competencies of public health dentists were not known to the students.
The subject was perceived as highly volatile by the students. >50% of the students responded that the subject deals with definitions which are difficult to remember. A considerable number of responses were obtained regarding difficulty in understanding and recording indices. Few students reported that the subject as such is extremely difficult to understand. Modifications in the teaching processes to make the subject more interesting and understandable was the most common suggestion received.
| Discussion|| |
This study attempts to quantify the relative difficulty of PHD and to comprehend students' attitudes towards the specialty of PHD using a semi-structured self-administered questionnaire. The primary objective was to gain insights into why the specialty of PHD does not enjoy coveted status among undergraduate students. In the present study, quantitative analysis of marks obtained by undergraduate dental students in final year curriculum preceded qualitative analysis on a subsample to explore in detail the attitudes toward the specialty.
The study yielded diverging results in its quantitative and qualitative components. While PHD as a subject was found to be the third easiest subject in the quantitative analysis, students' responses place the subject at the second position in the descending order of difficulty. These contradicting results perhaps are not very surprising, since the study deals with a complex human experience of “difficulty.” The interpretation of results in the study does not aim to judge which of these results was true, rather acknowledges that these contradicting results might each be gaining insights into different aspects of the outcome measure. The discrepancy between difficulty in PHD as analyzed by SPA and as perceived by students raises concerns among the inherent interest among students toward this specialty. This lack of interest was evident from previous findings with nominal number of students demonstrating positive preferences to pursue postgraduation in the specialty., Surprisingly, in a study among working dental public health specialists in India, almost one-third of the participants commented that they would not recommend PHD as a career for young graduates in dentistry.
A great majority of participants in that study opined that they were not getting enough recognition for their work. These observations throw light on the dissatisfaction prevailing among PHD professionals in India which could be reflected in the students' attitudes about the specialty and consequently their perceptions on the difficulty of this specialty as was observed in the present study.
The observation made in the study that PHD was a nonclinical, difficult, and boring specialty was quite unfortunate, and the roots for these perceptions lie in the mistaken fundamental understanding of this specialty by dental institutions. As rightly mentioned, PHD is not just a paper that has to be cleared to obtain the degree but is the dentistry for the entire nation. However, students from institutions where postgraduation in PHD was available had better perceptions in relation to the nature of the specialty. This could have been a result of the opportunity to closely observe the postgraduate curriculum in the specialty during their rotational postings. Significant differences between males and females with regards to their interest in the specialty was found which could be due to the more intimate interactions of males with external society compared to females in India, and the specialty does have a profound societal outlook.
The students in the present study were not equipped with the knowledge on what a Public Health Dentist specializes in. Their responses “conducting camps” and “recording indices” reflect the dismal understanding of the students about the competencies of a Public Health Dentist. However, even the postgraduate curriculum in PHD does not equip the professionals with required competencies as opined by the working public health dentists themselves. The almost exclusive response for the inquiry on career prospects for public health dentists was “academics.”
These findings highlight the dire need to reform the curriculum not only to bring a change in poor attitudes toward the specialty but also to equip students with the required competencies to continue their careers as public health dentists. The reasons for perceived difficulty in the specialty were difficulty in understanding indices, concepts, and memorizing the definitions. It was not within the students' understanding that the specialty does not deal just with definitions and indices but deals with health in general and oral health in particular as a comprehensive phenomenon. The students suggested a modification in teaching the specialty.
The fact that performance in exams depends on a lot of other factors apart from difficulty cannot be ignored. The differences in inherent interest for a subject among students, the quality of teaching experience in different subjects at different institutions, etc., limit the scope for judging difficulty solely based on comparison of outcomes (academic performance). The qualitative analysis was conducted in only three of the twenty-five dental institutions affiliated to Dr. NTR University of Health Sciences. Therefore, these results could only be understood in terms of their merits in gaining important insights into the reasons for poor attitudes towards the specialty, but could not be considered as qualitative results in true sense due to the lack of application of saturation methods in obtaining conclusive results. Nevertheless, this study is one of the first attempts made to quantify relative difficulty and to gain insights into difficulty in PHD as perceived by students on a qualitative basis. In the present study, semantic differential scale was preferred to Likert scale to eliminate the possibility of acquiescence bias.
| Conclusion|| |
Health for all is a primary goal for any society and so is oral health. To realize this goal of providing oral health care equitably for all the people in the society, we need future dental professionals who are empathetic, humane, and with adequate exposure to diverse socioeconomic conditions besides technically being skillful. The Department of PHD provides an excellent opportunity to get equipped with the forestated qualities. The findings of this study signify the need to adopt new strategies in making the subject more interesting and understandable for students. It is incumbent on all the PHD professionals to make the future generations in dentistry realize the beauty of PHD, and to indoctrinate amongst them the fact that PHD sits at the fundamental foundation for improving the oral health status of a nation's populace.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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