Australian Dental Journal

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1 Australian Dental Journal The official journal of the Australian Dental Association Australian Dental Journal 2014; 59: 2 8 doi: /adj The effect of a change in selection procedures on students motivation to study dentistry SP Gardner,* KF Roberts-Thomson* *Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia. ABSTRACT Background: The aim of this study was to determine whether changes in student selection criteria at The University of Adelaide effected a change in motivation and influencing factors to study dentistry by comparing cohorts. Methods: Online questionnaire completed by first-year dentistry students at The University of Adelaide between and Results: All 666 students completed the questionnaire with 647 suitable for analysis. The likelihood of students being motivated for a career in dentistry because it fits with family was greater for the cohort (OR = 1.68, 95% CI = , p < 0.01) than it was for enrollees, whereas status became less important (OR = 0.47, 95% CI = , p < 0.01). Being influenced by a dentist (OR = 2.41, 95% CI = , p < 0.001) or a dental employee (OR = 3.19, 95% CI = , p < 0.001) was much greater for the group than it was for the cohort. Where students came from, parents level of education and gender were not significant in the multivariate analysis of factors associated with motivation and influences of students career choice. Conclusions: Changes to the selection procedure were associated with increased emphasis on lifestyle factors and the dental profession, but not with the desire to help people or the importance of the work itself in students decision to study dentistry. Keywords: Career choice, dental students, dentists, motivation, selection. Abbreviations and acronyms: UMAT = Undergraduate Medicine and Health Sciences Admission Test. (Accepted for publication 5 June 2013.) INTRODUCTION Since the 1960s, Australian students motives to study dentistry were similar to those of students from other countries with the prime motivating factors being independence of employment, working with people and the anticipated income. 1,2 The perceived status of dentistry has been reported to be of importance to students in the United Kingdom (UK), North and South America, and Denmark. 3 7 More recently, cultural differences have been identified as influencing factors. 8 Parents and dentists have been reported to be very influential when students decide to study dentistry. 1,9 11 Australian studies have also identified gender differences when choosing a career in dentistry but have not found significant differences between males and females in relation to motivational factors. 12 The priority that males and females placed on the various motivational factors was the only difference observed. Males were more attracted to the income and status of dentistry, whilst females were more attracted to the nature of the work, the desire to work for and with people, and the compatibility with anticipated family commitments. The influence of which country the students have spent most of their lives on motivation to study dentistry has not been investigated. Comparative studies of students from different countries and their motivation toward career choice have been investigated. 13,14 This study, therefore, will reflect the trend of a more multicultural Australian population, with a growing number of students from different ethnic backgrounds entering dental schools. 2,15 It will determine whether there are differences in the career aspirations of students who have spent most of their lives in Australia compared to elsewhere, and if these differences are associated with the change in the selection procedures. The career aspirations of the children of baby boomers, known as Generation X and more recently Generation Y, have also not been explored. The students in this study are largely representative of Generation Australian Dental Association

2 Dental students career choice and selection X (born ) and Generation Y (born ). 16 The University of Adelaide s School of Dentistry adopted a new selection process in 1997 from one based solely on academic merit to one which was a combination of academic merit, performance in the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and a structured oral assessment. 17 The UMAT was adopted by several Australian universities and used a screening tool to aid in the selection of students more suited to careers in health professions rather than being based on academic performance alone. The interest in this study was to build on previous work of this study population, 2,18 and focus on the changes after 1997 in motivation and influencing factors after controlling for where students had spent most of their lives (irrespective of their country of birth), gender, age, and parents educational background. Motivating factors, in the context of this research were internal to the individual, whilst influencing factors were those individuals who had influenced the students decision to study dentistry. The aim of this study was to determine whether motivation and influencing factors to undertake dentistry at The University of Adelaide from the period 1993 to 2005 changed following the implementation of the new selection process. In particular, this study was designed to detect if the selection procedure reflected changes in the desire to help others through the important work of a dentist. help people, the status of dentistry, anticipated income, good working hours, security of the job, opportunity to be self-employed, work would be interesting, work fits in with family commitments, work is important and the pleasant working surroundings. The respondents could answer Yes or No to more than one statement. Respondents were also asked to indicate who influenced their decision to choose dentistry as a career. The nine options given were father, mother, another relative, family friend, dentist, another dental employee, career counsellor, teacher at school and school friends. Father and mother were combined and relabelled parent. The remaining eight became the dependent or outcome variables and referred to as influences where the response was either Yes or No to the statements. Independent variables The independent variable of year of selection was dichotomized into and representing students chosen before and after the changes to the selection process. Other variables were location, age, gender, and parent level of education. Location was determined by whether the students had resided most of their life in Australia or overseas. Age was dichotomized into less than 21 years and 21 years or more. The parent level of education was determined by whether either parent was a university graduate or not. METHOD The study was a cross-sectional survey of all students enrolled in the second semester, first-year Bachelor of Dental Surgery programme at The University of Adelaide between 1993 and The self-complete online questionnaires were coordinated by dental school staff and comprised 32 questions. The sociodemographic data collected included age, gender, place of residence during non-term time, country of birth, academic background of student and family, career preferences and value orientations toward their and others perceived dental health. The variables used in relation to students motivation to study dentistry and factors influencing their career choice, were based on previous studies over a 30-year period so that comparisons between similarities and differences were possible. 2,5,12,18 22 Dependent variables Students were asked to indicate which of the 10 statements given were relevant to their motivation to become a dentist. The statements were: your desire to Data analysis Statistical Package for the Social Sciences (SPSS 17) was used to analyse and manage the data. The data were cleaned and missing values identified. Frequency distributions for the variables relating to the students motivation and influencing factors in their decision to choose dentistry as a career were calculated. Crosstabulation and chi-square analyses were used to compare demographic characteristics of selected variables of the population. A 5% level of significance was used for all tests. Following the bivariate analyses of the dependent motivation and influences variables with the independent variables, those with a chi-square p-value less than 0.20 were used in multivariate analysis. Using this criterion, the response variables included in separate logistic regression models were status, good hours, job security, fits with family, pleasant surrounds, family friend, dentist and dental employee. The predictor variables were location, age, gender, year of selection, parent level of education. Observations were deleted if any were missing a value for any of the responses or predictor variables. Odds 2014 Australian Dental Association 3

3 SP Gardner and KF Roberts-Thomson ratios (ORs) with 95% confidence intervals (95% CIs) and the Nagelkerke R-squared were computed. Approval to conduct this study was granted by the Human Research Ethics Committee of The University of Adelaide. RESULTS Response rate Comparable data sets were collected from all firstyear undergraduates from 1993 to 2005 inclusive. All 666 students completed the online questionnaire, of which 647 questionnaires were suitable for analysis (97.1%). Table 2. Frequencies of affirmative responses for motivation and influences statements from the total student population Motivation variable n % Influences variable n % Job security Dentist Interesting work Parent To help people Family friend Opp. for selfemployment Relative Good working hours School friend Anticipated income Career counsellor Important work Dental employee Status of dentistry Teacher Fits with family Family friend Pleasant work surrounds Descriptive statistics Table 1 shows the characteristics of the total student population. There were slightly more females (53.2%) than males in the study. Almost twice as many students were local (62.4%) compared to those who were from overseas (37.6%). Three-quarters (76.0%) were less than 21 years of age and a quarter (26.1%) were selected into the dentistry programme before the change in the selection procedure. Two-thirds of students had one or both parents who were university graduates (63.5%). The four most reported motivation factors for the total student population were job security, interesting work, to help and opportunity for self-employment with over 80% responding affirmatively for each statement (Table 2). Fits with family (54%) and pleasant work surrounds (48%) were the least reported statements. The person who had the most influence of students career decision was the dentist (53.7%) followed by parent (44.9%). Career counsellors (11.7%) dental employees (9.4%) and teachers (7.1%) had very little Table 1. Selected characteristics of total student population (n = 647) from Characteristic n % Location Local Overseas Gender Male Female Age <21 yrs yrs Year of selection Parents education Graduate Not graduate influence when it came to student career choice (Table 2). Bivariate analyses Table 3 shows the associations between student characteristics and year of selection. There was a statistically significant difference (p < 0.01) between the age profiles of the students in the cohorts and There was almost four times the number of younger students in the latter cohort (78.7%) than those 21 years and over (21.3%). In the earlier cohort, the age split was not as pronounced (68% <21 years, 32% 21 years). There were significantly more local students (64.8%) compared with overseas (35.2%) in the group (p < 0.05). The association between year of selection and parent education was significant (p < 0.01), with more parents of the group having university degrees (66.7%) than parents of the earlier selected group (54.4%). There was no significant association between gender and year of selection. Table 3. Associations between selected student characteristics and year of selection Characteristic n = 169 n(%) n = 478 n(%) Location Local 94(55.6) 309(64.8) Overseas 75(44.4) 168(35.2) * Gender Male 78(46.2) 225(47.1) Female 91(53.8) 253(52.9) ns Age <21 yrs 115(68.0) 376(78.7) 21 yrs 54(32.0) 102(21.3) ** Parents Education Graduate 92(54.4) 317(66.7) Not graduate 77(45.6) 158(33.3) ** *p < 0.05; **p < 0.01; ***p < 0.001; X² test. p Australian Dental Association

4 Dental students career choice and selection Table 4 shows the cross-tabulation of the dependent and independent variables which revealed a statistically significant association between year of selection and age with the motivation variables. There were statistically significant differences between the two year-of-selection student cohorts in four of the factors which motivated them to study dentistry. Work conditions such as good hours (69.2 to 77.1%: p < 0.05), fits with family (43.2 to 59%: p < 0.001) and pleasant surroundings (39.6 to 51.1%: p < 0.05) were more important factors for the cohort than the group. Status (78.7 to 67.1%: p < 0.01) on the other hand, was less important for the cohort. There was not a statistically significant difference in the importance of other workrelated factors on selecting dentistry between the two student cohorts including wanting to help and doing important work. Students aged less than 21 years were more likely to be motivated by good hours (78.5 to 64.3%, p < 0.001), fits with family (57.8 to 45.4%: p < 0.05), job security (88.7 to 82.1%: p < 0.05) and pleasant surrounds (51.2 to 38.3%: p < 0.01) than students aged 21 years or more. There was a significant association between parents education level and the student being influenced by the good working hours of dentistry. If either parent was a university graduate, the students were more likely to be motivated by good hours (77.6 to 70.3%: p < 0.05) than if their parents were not graduates. Location and gender revealed no significant associations in the same analyses. Table 5 shows the comparison between the two cohorts where students from were significantly more influenced by a dentist (60.3 to 35.5%: p < 0.001), almost three times more influenced by a dental employee (11.3 to 4.1%: p < 0.01) and nearly twice as influenced by a family friend (25.3 to 14.2%: p < 0.01) than the cohort. The influence of another dental employee was significantly associated with the parent not being a university graduate (12.6 to 7.3%: p < 0.05) than if they Table 4. Associations between career choice motivation and selected demographic variables Motivation variable n Year of selection p Gender p Age p Location p Parent education M F <21 yrs 21 yrs Local O seas Grad NotGrad p % % % % % % % % % % To help ns ns ns ns ns Status ** ns ns ns ns Income ns ns ns ns ns Good hours * ns *** ns * Opp. selfemployed ns ns ns ns ns Fits with *** ns * ns ns family Job security ns ns * ns ns Interesting ns ns ns ns ns work Pleasant * ns ** ns ns surrounds Important work ns ns ns ns ns *p < 0.05; **p < 0.01; ***p < 0.001; X² test. Table 5. Associations between influences towards career choice and selected demographic variables Influences variable n Year of selection p Gender p Age p Location p Parent education M F <21 yrs 21 yrs Local O seas Grad NotGrad % % % % % % % % % % p Parent ns ns ns ns ns Relative ns ns ns ns ns Dentist *** ns ns ns ns Dental ** ns ns ns * employee Teacher ns ns ns ns ns Counsellor ns ns ns ns ns School friend ns ns ns ns ns Family friend ** ns ns ns ns *p < 0.05; **p < 0.01; ***p < 0.001; X² test Australian Dental Association 5

5 SP Gardner and KF Roberts-Thomson were. Gender, age and location were not significantly associated with person or persons having an influence over career choice. Multivariate analyses Logistic regression models (Table 6) were created for each of the outcome variables that were significant at p < 0.20 in the bivariate analyses. The motivation variables of status and fits with family were statistically significant after adjusting for age, gender and parent education. Family reasons were more of a motivator to choose dentistry for the group (OR = 1.68, 95% CI = , p < 0.01) with status becoming less important than it was for the earlier cohort (OR = 0.47, 95% CI = , p < 0.01). The odds of being influenced by a dentist and dental employee were more than double for the cohorts after the changes to selection in More specifically, being influenced by a dentist was almost two and half times more likely for the group (OR = 2.41, 95% CI = , p < 0.001) and by a dental employee, the odds were three times greater (OR = 3.19, 95% CI = , p < 0.001). The Nagelkerke R-squared value for models one and two was and respectively. DISCUSSION The key finding in this study was that there was not a statistically significant difference in the proportion of students from the and cohorts Table 6. Logistic regression showing the odds ratios (95% CI) of individual models of motivation and influences after adjusting for age, gender and parent education Model 1 Year of selection (1) v Motivation p Odds 95%(CI s) Status ** 0.47 ( ) Good hours Job security Fits with family ** 1.68 ( ) Pleasant surrounds Model 2 Year of selection (1) v Influences p Odds 95% (CI s) Family friend Dentist *** 2.41 ( ) Dental employee ** 3.19 ( ) **p < 0.01; ***p < 0.001; (1) = Reference 1; adjusted for age, gender and parent education. who reported altruistic reasons for undertaking dentistry (wanting to help people and important work). Whilst not significant, it is important to acknowledge that a clear majority of the respondents were motivated to help people (84%) and because of the important work (73%) and that these factors had become increasingly important for the more recent students. However, influencing factors did differ between the two cohorts. The latter was more likely to be influenced in their career decision-making by dental personnel (dentists and dental employees) than the earlier cohort. This suggests that the latter cohort were more informed about dentistry and what was involved in working as a dentist than those selected prior to the changes. It may also reflect students being more informed about the changes in the selection process. Whilst the influence of another dental employee was significant when comparing cohorts, the overall percentage reported was low. Younger students (less than 21 years of age) were more likely than older students to be attracted to dentistry for lifestyle reasons: good working hours in pleasant surroundings, security of employment and being able to fit in with family demands. The career choice reasons found to have statistically significant associations with both age and year of selection were not the ones that were the top priority to The University of Adelaide. The selection changes were introduced so that students more suited to a career of serving others in the treatment, prevention and control of oral conditions, were chosen. The results of this study show that this did not occur. Because the R-squared values for the logistic regression models were small, it is evident that the predictor variables explain only a small amount of each of the outcomes having an impact on career choice for both cohorts. The results of this study are similar to other studies 3 7,23 where students motivation to choose dentistry as a career appears to be universal. Males tend to place the business related motives and desire for independence slightly higher than females. Conversely, females place people orientated motives including the desire to help slightly higher than males. 10,12,24 Many of the motives such as perceived income, flexibility of work, and pleasant surroundings could be generally applied as reasons for choosing other careers although income did not rate highly as a motive in Whittaker s 22 study of dental students at one dental school in the UK. Vigild and Schwarz s 5 findings of a crosscultural universality when comparing Chinese and Danish students motivation are well supported. The authors concluded that the work of a dentist was clearly defined and therefore could be attractive to a particular type of student with similar perceptions of dentistry as a career. Further studies to link the Australian Dental Association

6 Dental students career choice and selection motivating factors of a first-year undergraduate to those practising dentistry may give an indication whether the motives of a first-year undergraduate were realistic or not. Whilst this study did not have the specific question relating to the desire for independence, the closest survey question to other studies was the opportunity to be self-employed. The results of this survey indicate a strong shift in emphasis from previous studies where the opportunity to be self-employed has been overshadowed to a degree by working conditions such as flexibility of hours, job security and family/lifestyle related factors. This trend toward lifestyle and income as motivating factors has become increasingly important of late to medical students career choice However, these general trends could well apply to many professions. 22 School teachers and career counsellors played a minor role in students decision to become dentists in this Adelaide survey, similar to the results reported by others. 2,4,28 The overall minimal impact could be that counsellors are simply not promoting programmes in oral health, they themselves lack information about dentistry as a profession, or that programme material has not been made available to school students. A choice is the process of selecting from two or more alternatives. The choice may be very subjective and is limited to options available. Many of the options given to students in this study could be the same for many careers. 29 Researchers 4,23 have recommended the need to delve deeper to find the real value and meaning of motivating factors specific to dentistry. If students in this study were asked to rank their motivating factors, a different order of responses may have been found. Whilst the reliability of self-reported questionnaires for data collection has its limitations, this survey was carried out at the same time in the academic programme for each cohort and the wording of the questions remained unchanged. A good feature of this study is the 100% participation rate ensuring that the views of all students from 1993 to 2005 were obtained. The results of this study may also reflect a generation change with the Generation X ers (born ) making up the cohort and the Generation Y s (born ) making up the majority of the cohort with the change occurring after Generation X ers are typically characterized as individualists, comfortable with change, more independent and self-sufficient than previous generations who are more likely to seek out more than one job, open to more challenging options offering higher salaries or improved benefits. 16,30,31 Personal values and goals are regarded higher than work related goals, such as quality of life rather than standard of living. 16,30,31 This Generation has also been reported to place emphasis on family and friends first when it comes to choices and are very often driven by independence, stability and loyalty. 16 Follow-up studies of subsequent cohorts from The University of Adelaide would determine if this trend still exists. The results which were significant for reasons given for career choice for students less than 21 years were the same as for students in the latter cohort. This is not surprising given that the majority of students fell into this age category (75.9%). This study shows a marked increase in a family friend having an influence over career choice than from earlier cohorts. It could well be that the family friend is actually a dentist. A study of the same student group by Stewart et al. 18 found that the social profile of students did change after 1997 with more coming from privileged backgrounds. Exactly how much importance should be placed on those influencing career decisions is unclear. The results of this survey show that the dentist and other dental employees have a significant influence over students choice to study dentistry. 32 Being influenced by people in the profession was an important finding in this study contrary to Whittaker s 22 findings relating to British students. Whilst this study demonstrated that career choice was influenced significantly by dentists, it does not indicate where those dentists were located. For example, do dentists in rural and remote regions have the same influence on career choice as those in more populated areas? Perhaps members of the profession could be supported in promoting their career to prospective applicants in the hope that future dentists are representative of the total population. Two questions still remain and require further research: (1) How much emphasis should be placed on altruistic motives when selecting students for dentistry? (2) Are students being selected on the basis of having a genuine interest in meeting the oral health needs of Australians? The results of this survey will provide useful insights for staff involved in the selection and recruitment of incoming students into dentistry. CONCLUSIONS The changes to student selection procedures at The University of Adelaide in 1997 did not change the proportion of first-year students who identified altruistic motives such as the desire to help people, among their reasons for studying dentistry. The selectors of students into the programme have yet to determine the best method of selecting dental students Australian Dental Association 7

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The future of the profession a survey of dental school applicants. Br Dent J 2004;197: ; quiz 577. Address for correspondence: SP Gardner Australian Research Centre for Population Oral Health School of Dentistry The University of Adelaide Adelaide SA sue.gardner@adelaide.edu.au Australian Dental Association