Research into the motivation of individuals. Dental Students Motivations and Perceptions of Dental Professional Career in India

Transcription

1 Dental Students Motivations and Perceptions of Dental Professional Career in India Amit Aggarwal, M.D.S.; Sonia Mehta, M.D.; Deepak Gupta, M.D.S.; Soheyl Sheikh, M.D.S.; Shambulingappa Pallagatti, M.D.S.; Ravinder Singh, M.D.S.; Isha Singla, B.D.S. Abstract: Students motivations in choosing a career in the health professions are of great interest for educators and admission committees, particularly in the field of dentistry. This study conducted in four private dental institutions in India was designed to investigate dental students motivations in their choice of dentistry as a career and their perceptions regarding dentistry in India. A total of 400 questionnaires were distributed, and 369 students responded in a combination of selected responses to the questions, for a response rate of 92.3 percent. In the results, 53.7 percent of the students reported pursuing dentistry because it offers stable work (p<0.002); 38.7 percent because the profession is highly paid; and 7.6 percent due to the ease in finding a regular job in dental schools or hospitals. The survey also found that 44.4 percent of the students pursued dentistry because they can determine their own hours of work and 36.6 percent said they liked to be their own boss. Among these students, 64.5 percent said they were content to be joining dentistry as a professional course, but 35.5 percent were discontented (p<0.001). Regarding the specialties, 79.1 percent said they want to become specialists in the field of dentistry (p<0.001); oral surgery was the leading choice followed by orthodontics. Only 11.7 percent reported wanting to pursue dentistry for research purposes. Overall, this study found that financial and professional factors were the chief criteria for students pursuing dentistry in India; however, the strongest influence in the choice of dentistry was the students parents or family. Dr. Aggarwal is Assistant Professor, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India; Dr. Mehta is Assistant Professor, Department of Microbiology, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India; Dr. Gupta is Senior Lecturer, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India; Dr. Sheikh is Professor and Head, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India; Dr. Pallagatti is Professor, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India; Dr. Singh is Senior Lecturer, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India; and Dr. Singla is a Postgraduate Student, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India. Direct correspondence and requests for reprints to Dr. Deepak Gupta, Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India; phone; fax; drdeepak_26@rediffmail.com. Keywords: dental profession, dental students, career choice, dental specialties, India Submitted for publication 6/14/11; accepted 1/16/12 Research into the motivation of individuals who choose dentistry as a professional career demonstrates a wide range of motivational factors. 1-4 Since the dominant motivational factors may vary over time and between countries, seeking an understanding of current motivations to enter the health care workforce is critical to health care systems and may result in major change for policies in dental education. Dentistry provides a range of career and business opportunities, with career opportunities as a general practitioner as well as a specialist. In India, the recognized specialties are oral medicine and radiology, oral and maxillofacial surgery, oral pathology, prosthodontics, orthodontics, preventive and community dentistry, pedodontics, periodontics, and conservative dentistry and endodontics. 4 Prior to 1966, all the dental colleges in India were government-aided. In that year, the first dental college in the private sector was established. 5 By 2010, there were thirty-nine government dental colleges and 252 private dental colleges approved by the Dental Council of India. 6 The end of the twentieth century and the beginning of the twenty-first century show increases in enrollment numbers. By , approximately 23,690 students per year were graduating from dental colleges in India, resulting in a dentist to population ratio of 1:10,000 in urban areas and 1:20,000 in rural areas. 6 In India, the study period for the Bachelor of Dental Sciences is five years, which consists of four years in a study course and a one-year compulsory rotation internship Journal of Dental Education Volume 76, Number 11

2 Students motivations for choosing a career in the health professions is of great interest for educators and admission committees, particularly in the field of dentistry. 7 Also, assessing the level of satisfaction among dental students provides a key barometer of the future of dental education in any country. 8 There is a serious lack of authentic and valid data for assessment of dental students motivations to enter and attitudes about the field of dentistry in India. The professional socialization of dentists (which means achieving professional status within a social context) begins with admission to dental school and continues through the entire study period of the student. 9 Thus, it may be assumed that students motivations for choosing dentistry as a career and satisfaction level may differ amongst students who already are pursuing dentistry compared with those who are on the verge of choosing it. The choice of a career is influenced mainly by advice from parents, relatives, friends, teachers, and counselors. 10 The choice of a career is a critical decision because it has an obvious impact on the individuals future life pattern. 9 At present, the number of people being admitted to dental colleges in India is decreasing as the rapid growth in the number of dentists tends to discourage some prospective candidates who feel that the increased competition would limit their future earnings. 11 The purpose of our study was to explore motivational factors that influenced students to choose dentistry as a profession and students perceptions regarding admission process and dental education. Materials and Methods The study was conducted among randomly selected private dental colleges of Punjab and Haryana in India. Before beginning, we gained approval from the Ethical Committee of Research at M.M. College of Dental Sciences and Research. The total twenty dental colleges in these regions include both private and government dental colleges. Only private dental college students were chosen in order to avoid bias. A staged simple random sampling method was used to select four colleges. In these colleges, a total of approximately 1,200 students were enrolled at the time of this study. The students who were absent or were taking their supplementary tests on the day of the survey were eliminated from the study. Further elimination was done to maintain approximately equal representation of students from each year. Thus, a total of 400 students were randomly selected from all years of the dental course (first year to interns) to keep minimal bias. The purpose of the questionnaire was clearly explained to the participants. A self-administered structured questionnaire of fourteen items, written in English and designed to assess factors for choosing dentistry as a career, was adapted from previous studies. 4,9 (Contact the corresponding author for a copy of the questionnaire.) Four hundred questionnaires were distributed among the selected dental students. Participants were asked to complete responses to this paper and pencil survey in a couple of pages. No identifying information was included on the instrument. Subsequently, all the questionnaires were collected and analyzed. The questionnaire consisted of a combination of selected response to the questions and close-ended questions (yes/no). Two themes were addressed: the students decision to pursue dentistry and their perceptions of a career in dentistry. The questions were designed in accordance with the factors affecting students decision in choosing a career; these included personal, economical, professional, and other factors. It took about ten minutes to complete the questionnaire. Chi-square statistics were computed to determine differences between selected demographic variables regarding factors for pursuing a career in dentistry, the dental school application process, and perceptions of a career in dentistry. Using these statistics, we calculated the numbers of variables. Descriptive statistics were used to report percentages of respondents on selected variables. Data reported in this study were analyzed by using SPSS Results Of the 400 potential participants, 369 students completed the questionnaire for a response rate of 92.3 percent. Of the 369 students, 73.7 percent (n=272) were female and 26.3 percent (n=97) were male (Table 1), with ages ranging from eighteen to twenty-five years and a mean age of 20.50±1.72 years. All years of dental school were represented equally with maximum response from interns (21.4 percent), followed by second- and third-year students (20.6 percent each) and first- and fourth-year students (18.7 percent each). The difference in numbers was non-significant. Among these students, 67.2 percent (n=248) took a preparatory course before entering dental school; of those, 60.8 percent (n=59) were male and 69.5 percent (n=189) were female. Also, November 2012 Journal of Dental Education 1533

3 79.9 percent (n=295) said they found the admission process difficult. Choice of Dentistry as a Career Students were asked about a wide range of influences on their choice of a professional career in dentistry (Table 2). Among the potential motivating factors, 97.7 percent (n=368) said they were encouraged by their family to seek dentistry as a professional career; 53.7 percent (n=198) said they pursued dentistry because it offered stable work (p<0.001); 23 percent (n=85) wanted to earn a lot of money; 15.7 percent (n=58) said the profession is highly paid and profitable; and 7.6 percent (n=28) said it is easy to find a regular job in dental schools or hospitals. In addition, 44.4 percent (n=164) said they pursued dentistry so they can determine their own hours of working; 36.6 percent (n=135) liked to be their own boss; and 5.7 percent (n=21) did not like to be salaried. Table 1. Distribution by year of males and females and total number of students in study, by number and percentage Year Males Females Total First year 21 (30.4%) 48 (69.6%) 69 Second year 11 (14.6%) 64 (83.4%) 75 Third year 19 (25.3%) 56 (74.7%) 75 Final year 22 (31.9%) 47 (68.1%) 69 Intern 24 (29.6%) 57 (70.4%) 81 Total 97 (26.3%) 272 (73.7%) 369 In responses to other questions, 57.5 percent (n=212) said they pursued dentistry because they like to help people in general, while 23.3 percent (n=86) reported liking to have a manual skill for themselves and 19.2 percent (n=71) to interact with people. Among these students, 38.8 percent (n=143) said they did not have the grades to get into medical school, while 25.7 percent (n=95) said they chose dentistry to avoid on-call or night duties, 15.4 percent (n=57) said they did not like the long working hours associated with the medical profession, and 20.1 percent (n=74) said they thought the medical stream (graduation in medicine from a medical college) was a long and difficult career path. Perceptions of Dental Education and Future Plans In their responses, 64.5 percent (n=238) of the students said they were content to be in dentistry as a professional course, but 35.5 percent (n=131) said they were discontented; the difference was significant (p<0.001) (Table 3). Of the total 238 contented students, the maximum content level was reported by first-year students (n=51). Of the total 131 discontented students, the maximum discontent level was reported by interns (n=32). The factors for discontent were mostly stressful life (27.5 percent), long duration (14.5 percent), and difficult studies (6.9 percent); 51.1 percent checked all these three factors (Table 4). Among all responding students, 92.1 percent (n=340) were satisfied with the teachers Table 2. Motivational factors for choosing dentistry as a career, by number and percentage of total respondents p-value Motivational Factors Number Percentage (chi-square) Economic It is easier for a dentist to find a job % 0.002** I want to make a lot of money % Dentistry offers stable work % Dentistry is the best paid among the available careers % Professional I can determine my own hours % 0.012* I can be my own boss % I can earn money every day % I will not be on a salary % Vocational I like to interact with others % <0.001** I like helping people % I have manual skills % Personal There are dentists in my family, and I was encouraged by them %.(a) My family and friends encouraged me to study dentistry % *Statistically significant; **Highly statistically significant;.(a) denotes very very highly significant value 1534 Journal of Dental Education Volume 76, Number 11

4 and other staff members of the school, but 7.9 percent (n=29) were not satisfied. For these students, 79.1 percent (n=292) said they want to become specialists in the field of dentistry (p<0.001), while 8.4 percent (n=31) want to become educators and 7.9 percent (n=29) want to practice general dentistry. The most frequent choice of specialty was oral surgery (33.9 percent, n=125), followed by orthodontics (23.3 percent, n=86) and endodontics (21.1 percent, n=78). Factors reported for choosing a specialty were professional status (39.6 percent), high income (30.6 percent), better job options (12.2 percent), interest in research in a particular branch (11.7 percent), and family background (1.4 percent) (Table 5). For this group of students, 66.9 percent (n=247) said they want to go abroad in the future for further enhancement in the dental field. Better opportunity for studying there was reported as the leading factor (30.1 percent), followed by better income (16 percent), not liking the status of dentistry in India (12.5 percent), and family abroad (8.4 percent). Discussion The results presented here are the first reported data regarding the factors involved in the choice of dentistry as a career by dental students in India in the current era. Dental students motivations for pursuing dentistry as a career were found to be chiefly economic and professional. The students were also encouraged by their families for the reasons of higher income, professional status, interpersonal motives, self-employment, career opportunities, working with people, and interest in science. 12 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. 12 Table 3. Number of contented and discontented students, by year Year Contented Discontented Total First year Second year Third year Final year Intern Total Motivations for Choosing Dentistry In India, most students live with their families, and their parents play an important role in making decisions in the students lives. This situation is comparable to that in studies conducted by Karibe et al., 12 Marino et al., 13 Jover et al., 14 and Tangade et al., 15 who reported that parents were very influential among Asian students. Almost all the students in our study (99 percent) were encouraged by their parents to pursue dentistry as a professional course. Our study revealed that students in India are highly influenced by their families in making important decisions. This trend sometimes questions the independence exercised by individuals in choosing the vocation that may determine the future course of their lives. Changes could be made in the curriculum of the lower classes and in the admissions process that would lead to independent thinking regarding the choice of career by the students. A number of studies have found that dentistry was not the occupation of choice for most students and that medicine was the general preference. In India, admission into the medicine/dentistry course is highly competitive and requires a high grade on the admission test, which is in multiple-choice format. Entrance examinations usually assess the applicant`s knowledge in fundamental sciences; some universities place an emphasis on biology. As a result, stu- Table 4. Factors causing discontent among discontented students (N=131; 35.5 percent of total) Long Duration Difficult Study Stressful Life Combined Factors Total by Year First year Second year Third year Fourth year Interns November 2012 Journal of Dental Education 1535

5 Table 5. Factors for choosing each specialty Scope Can Give Family Better Job High Professional for Further Experience Specialty Background Option Income Status Economic Status to Branch Orthodontics Endodontics Prosthodontics Oral Surgery Oral Medicine Oral Pathology Community Dentistry 1 1 Pedodontics Periodontics 2 2 dents who are not accepted into medicine may decide to go into dentistry. A few universities have additional criteria. A passing grade in Gandhian thought is a prerequisite for entry into Mahatma Gandhi Institute of Medical Sciences, Sevagram, while fifty out of sixty seats in Christian Medical College (CMC), Vellore, in 2009 were under the sponsored category. Candidates applying in this category are sponsored by Christian organizations that are members of the CMC Vellore Association or Council. In our study, 38.3 percent of the students chose dentistry as a result of not getting admitted to medical college because of not making the required grades. This situation may lead to a frustrated professional, aggravated by the fact that the choice of career was not made for vocational factors. 16 The implication of this factor can be far-reaching as the professional may not be a good dentist borne out of the fact that he or she did not get admission to the medical college in the first place. The admission process needs to be changed so that only those students who have an interest in dentistry should be able to get admission into dental colleges and not those who enter because of not making the required grades for medical colleges. Understanding the factors that lead to the choice of career is important because that decision establishes expectations for one s future and may affect one s satisfaction with the career. 7 Surveys of dental students in the United Kingdom and Israel revealed a primary interest in professional status, financial rewards, and security. 12 In the same study, 74.2 percent of Canadian and 32.8 percent of Thai students indicated economic/social factors. 12 In our study, stable work (53.7 percent) was found to be most valid factor for choosing dentistry. This is comparable to the findings of Aguiar et al., 7 who reported 51.1 percent of their students giving the same factor. Financial factors (38.7 percent) were also given a high priority for choosing dentistry in our study, which is in accordance with that in a previous study. 7 Among professional factors, in our study being able to determine one s own working hours (44.4 percent) was given primary emphasis, followed by being one s own boss (36.6 percent), ability to earn more money (13.3 percent), and not wanting to be on salary (5.7 percent). These findings are slightly different from the study of Aguiar et al., 7 who found that being one s own boss (30.5 percent) was given the highest priority followed by determination of own working hours. Bernabé et al. 17 also found that, among the professional factors for choosing dentistry, the fact that a dentist is his or her own boss outweighed all other considerations. In our study, the most prevalent professional factor for choosing dentistry as a career was the fact that dentists can determine their own working hours and be their own boss. In our study, the economic and social factors that lead to financial security and professional satisfaction were reported to be of the highest priority; this reflects the deep influence monetary factors have on the minds of majority of the students. Also, the social status attached to practicing dentistry played a major role in students choosing this field. Qualitative research in one study supports the view that features of a professional job are important; that study concluded that the underlying motivation for dentistry was the desire for a professionally contained career in health care and that students were attracted by aspects of a job that they perceive to offer security, flexibility, and quality of life Journal of Dental Education Volume 76, Number 11

6 Perceptions of Dental Career In our study, 79.9 percent of the students said they found the admissions process difficult. The admissions process is very competitive, and admission to a dental program is primarily based on a qualifying test comprised of multiple-choice questions. Students in India have to choose a medical or a nonmedical field after passing high school. Based upon that choice, for two years they enter a school/college for studying biology/mathematics. After qualifying in pre-university exams, they take another qualifying examination, which can be a private, public, or a national board exam. According to their grades obtained in the examination, the students gain admission to medical or dental school. 16 Similar to our findings, a study by Hawley et al. 18 also found that the majority of their respondents (72.8 percent) perceived the dental school application process as difficult. However, the process of admission in India is markedly different from the admissions process in the United States, United Kingdom, and Canada, where academic ability and personal qualities as evidenced by predental scholastic records, aptitude tests, letters of recommendation, personal essays, and personal interviews are all considered. In Japan, the entrance examination system also differs. 12 For admission to private schools there, candidates take examinations conducted by the individual dental schools, and there are several types of entrance examinations conducted by private schools. There is also a nationwide multiple-choice examination, a school-based written examination, a personal essay, a personal interview, and an entrance examination upon official recommendation by a high school principal, which includes a candidate essay and an interview process. In France, admission in the first year of medical or dental school is free for any student who has passed his or her baccalaureate after completing secondary school. 19 At the end of the first year, a selection of the students is made, according to a nationally predetermined figure, leading to a 1/10 selection. This first (selective) year is common to both medical and dental schools. At the end of the year, the students write final competitive examinations and, according to their ranking and preference, enter either into medical or dental school. 19 In our study, the results showed that dentistry in India is increasingly becoming a source of discontentment among the students as they progress from the first year to internship. The factors for discontent are consistent with those found in studies conducted by Yap et al. 20 and Tangade et al. 15 Regarding satisfaction with teaching faculty, our study found that Indian students are comparatively more satisfied than found in a comparable study. 12 We can speculate that, in India, the increase of dentists per population in urban areas and the expected decrease in financial gains from working in rural areas will cause frustration of the previous expectations of those who chose dentistry as a career. Though the level of teaching remains high indicated by the high percentage of students who are satisfied with their teachers a significant number of students are discontented with their choice of dentistry as profession. This finding makes us wonder if, in India, dentistry as a profession is beginning a downward spiral that may lead to a decrease in students who wish to pursue that career. In our study, 79.1 percent of the students said they want to become specialists in the field of dentistry, while only 7.9 percent want to practice general dentistry. This is different from other countries; a majority of Japanese (61.2 percent) and Canadian (51.6 percent) students, for example, said they had decided to work as general dentists. 13 In our study, respondents reported professional status and higher income as the chief factors for choosing to become specialists. The largest number of students said they wanted to become oral surgeons, followed by those who wanted to become orthodontists and endodontists. Research in the field of dentistry was a very low priority for these students in choosing a particular field. The high percentage who intend to specialize may be a result of the increasing number of specialization courses in India over the last few years and the high monetary gains by practicing in a specialty field. Our study found that 30.1 percent of the students want to go abroad in the future because of better opportunities of study, 16 percent for better income, and 8.4 percent because of family abroad. In the study by Karibe et al., 35.5 percent of students in Canada and 44.2 percent in Thailand preferred working abroad; reasons given were participation in a specific postgraduate program at an overseas university or hospital, working as a researcher in an overseas laboratory, working at a clinic or managing their own clinic after obtaining an overseas dental license, and international volunteer activity. 12 We tried to explore the attitude of our current students towards the future of dentistry in India, and 12.5 percent of them found it bleak. This may lead to challenges in the future of dentistry in India as a high percentage of capable and contributing dentists may leave for foreign shores, November 2012 Journal of Dental Education 1537

7 depriving the Indian population of the advantages of practicing dentists and of workers contributing to the country s economy. On the other hand, work and study abroad give an opportunity to dentists in India to learn from the international universities and apply these skills in India in the future. There was a high percentage of female students (73.7 percent) in our study similar to that reported in the studies by Orenuga and De Costa 21 and Patel and Saiyed 10 and reflecting the fact that the number of women entering the dental profession has been growing in recent years. The high percentage of women in dentistry in India implies that increasing numbers of females have entered this field due to family factors as Indian families tend to think this profession will serve for their qualification deeds as well as for their matrimonial purposes. The limitation of the study is that the study is not representative of all Indian students pursuing dentistry. Also, students of public colleges were not included. This study did not compare motivational factors and perceptions according to gender and years. 22 Further investigations are needed for a deep analysis and identification of implications that may influence policy and admission decisions. Conclusions The results presented here are the first reported data of the factors involved in the choice of dentistry as an occupation by dental students in India. This study points to the fact that there is a serious need of reviewing the process of admissions for students to dentistry to improve the level of satisfaction. The motivational factors given in the study are not enough for the students to choose a vocation for their whole lives. There could be a correlation between motivation factors and discontent. There are several factors like independence to choose dentistry, which is lacking in India. The students should be in this career because they choose to be and not because of the fact that they could not get admission into medicine. This problem can be corrected by diligently following admissions policies, taking into account the present changes in students perceptions and trends around the world and how these changes can affect dental education in India. In the current scenario, professional status and high income are the major driving factors in the choice of dentistry as a profession, and the majority of dental students were found to be satisfied with their career. A large number of them (males and females) would like to continue further study in the profession by pursuing postgraduate studies, with oral surgery, orthodontics, and endodontics as the most popular specialties. 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. Acknowledgments We thank Dr. Uma Singh, Department of Humantics and Social Science, M.M. University, Mullana, for her expert guidance and help in preparation of our manuscript. REFERENCES 1. Gallagher J, Patel R, Donaldson N, Wilson N. Why dentistry? A quantitative study of final-year dental students views on their professional career. BMC Oral Health 2007;7. 2. Brand A, Chikte U. Choosing dentistry as a career: part I a comparison of student motives. J Dent Assoc South Africa 1992;47(11): Brand A, Chikte U. Choosing dentistry as a career: part II the meaning of motives. J Dent Assoc South Africa 1992;47(12): Gallagher JE, Clarke W, Eaton KA, Wilson NHF. Dentistry professional contained career in health care: a qualitative study of vocational dental practitioners professional expectations. BMC Oral Health 2007;7: Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68(7 Suppl): Dental Council of India. At: /Adental. html. Accessed: June 14, Aguiar CM, Pessoa MA, Camara AC, Perrier RA, Figueiredo JA. Factors involved in the choice of dentistry as an occupation by Pernambuco dental students in Brazil. J Dent Educ 2009;73(12): Haidar Z. Professional satisfaction among Saudi dental students. Saudi Dent J 1999;11(2): Gallagher JE, Patel R, Wilson NHF. The emerging dental workforce: long-term career expectations and influences a quantitative study of final-year dental students views on their long-term career from one London dental school. BMC Oral Health 2009;9: Patel D, Saiyed MH. Factors for choosing dentistry as a career: a study of first-year dental students, India. J Int Oral Health 2009;1: Bean CY, Rowland ML, Soller H, Casamassimo P, Sickle RV, Levings K, Agunga R. Comparing fourth-year dental student productivity and experiences in a dental school with community-based clinical education. J Dent Educ 2007;71(8): Karibe H, Suzuki A, Sekimoto T, Srithavaj MLT, Iamaroon A, Warita S, et al. Cross-cultural comparison of the attitudes of dental students in three countries. J Dent Educ 2007;71(11): Journal of Dental Education Volume 76, Number 11

8 13. Marino RJ, Morgan MV, Winning T, Thompson WM, Marshall RI, Gotjamanos T, et al. Sociodemographic backgrounds and career decisions of Australian and New Zealand dental students. J Dent Res 2006;70(2): Jover M, Doudoux D, Deveaux E. Representations of the dental surgery profession and the motivations given by second-year French students for applying for dental surgery. Eur J Dent Educ 2006;10(1): Tangade PS, Mathur A, Gupta R, Chaudhary S. Assessment of stress level among dental school students: an Indian outlook. Dent Res J 2011;8(2): Bal AM. Medicine, merit, money, and caste: the complexity of medical education in India. Indian J Med Ethics 2010;7(1): Bernabé E, Icaza JL, Delgado-Angulo EK. Factors for choosing dentistry as a career: a study involving male and female first-year students in Peru. Eur J Dent Educ 2006;10(4): Hawley NJ, Ditmyer MM, Sandoval VA. Predental students attitudes toward and perceptions of the dental profession. J Dent Educ 2008;72(12): Farge P, Virieux J, Doury J. Student satisfaction with curriculum modifications in a French dental school. Eur J Dent Educ 2000;4(3): Yap AU, Bhole S, Teo CS. A cross-cultural comparison of perceived sources of stress in the dental school environment. J Dent Educ 1996;60(5): Orenuga O, De Costa O. Characteristics and study motivation of clinical dental students in Nigerian universities. J Dent Educ 2006;70(9): Freire Mdo C, Jordao LM, de Paula Ferreira N, de Fatima Nunes M, Queiroz MG, Leles CR. Motivation towards career choice of Brazilian freshman students in a fifteenyear period. J Dent Educ 2011;75(1): November 2012 Journal of Dental Education 1539