The total number of Dental students registered from years 1-7 at the Faculty of Dentistry, Kuwait University at the time of the study was 173. A total of 147 completed the questionnaire, a response rate of 85%. The age range was 18-24 years old, with an average age of 21 years. Ninety three percent of respondents were females. Using the Contingency coefficient analysis for the association between gender and decision to choose dentistry, no statistical significance was observed (Table 1). The option “don’t know” was excluded from the calculation and treated as missing, since it does not show any agreement and may inflate the average (Table 1).
Regarding the respondents familial educational background influence on motivation, 86% had mothers with university degrees and 83% of fathers with university degrees; with only 1% of mothers being dentists and 17% of fathers being dentists.
When asked about their perception of what factor influenced their decision to select dentistry as a career; the personal decision predominated (75% of respondents agreed with this statement). Using the Contingency coefficient, a statistically significant relation between motivation to choose dentistry and personal decision was observed (Table 2).
In the quantitative data parents' influence played splitting roles between mothers and fathers ‘influences; 31% agreeing to the presence of fathers influence and 36% agreeing to the presence of mothers' influence. Relating the contingency coefficient to the father’s and mother’s influence and gender effects, only the mother’s influence was found to be statistically significant in decision making (Table 3).
Factors such as the influence of relatives, family friends, family dentists, or persons within the dental field, teachers, and friends had a 10 to 25% role.
The motivators to go into the field of dentistry as reported the desire to help was their main factor, followed by; interest in dentistry, working independently, financial opportunities, professional reputation, prestigious job perception, academic interest, interest in a branch of medicine, reasonable working hours, job opportunities, while job security was the least factor (Figure 1). When asked why medicine was not chosen as a career path, only 37% agreed that medicine would have been a longer, more difficult career path. Seventy-four percent felt that a career in medicine would involve long working hours, and 71% felt that medicine would be a stressful career. 7% of respondents felt that they wanted medicine but did not enroll in medicine because they did not have the grades for it. Only 2% of respondents regretted their choice of dentistry.
Three main themes were made from the qualitative data, which seemed to interrelate. The customary practice in qualitative research is to present direct quotations from the participants to illustrate these themes.
Theme 1: Influences on choice
The immediate family influences on career choice were the dominant feature “Most of my family members encouraged me to choose it”, “It wasn’t my choice from the start. It was chosen for me.” “My parents influenced my decision”. There was also the perception that daughters or sons tend to keep their parents happy by the choice they made. “My parents, they wanted me to be a dentist, so, I went for it.”
The advice that came from siblings, or cousins or distant family also had an influence, “My cousin also as a 7th-year dentist student, she helped me to decide entering dentistry”. Given the close culturally netted extending family ties in this region; the distant family involvement was not surprising. This was stronger if the parent or relative was within the profession “I think they were many factors from parents, from a family that worked as dentists but in the end, I still think this is my choice and if I wanted anything else I would have chosen it.”
Parents’ personal experiences through the generations also had some influence, “my dad was very supportive of the choice because he always wanted to be a dentist, but his dad made him choose medicine, and it’s that, so I guess my dad was living his dream with me”.
While there were parents, siblings, cousins and relative influences, there were those who made their own personal choice “No specific person has influenced me. My family and parents would just encourage in whatever field I would like to go to, and they were just supportive of whatever path I chose.” “No, nothing influenced my decision; I just decided.”
It is difficult to ascertain if culture underpinned family and participants choice and this was the true determinant in choice. The authors are more inclined to believe that family influence in general is formed by cultural and acceptable norms, particularly for females, who formed the overwhelming number of students; at least 90% of the dental students were females. “I agree, a female in our society has a lot of responsibilities, and the less working hours of a dentist compared to medical doctor usually contributed to my decision.”
Marriage and starting a family at a certain age is a very important culturally, particularly for females. “Most my family influenced me especially my brother who is a physician…. wanted me to choose dentistry because in the future I want to start a family, the work hours are a lot easier than being a physician, so that made up my mind,” However, some, particularly females were rebelling against these preconceived cultural norms, of what career is suitable for a male and that for a female “I don’t like feeling that I’m less because I’m a girl and therefore I have to go into dentistry as opposed to medicine which is a lot tougher and more difficult or you have to work longer, like don’t get me wrong like comfort appears like I feel silly but like I don’t know, I just don’t like it when people say that it’s better for me because I’m a girl.”
Some choices were logically based, on work-life balance, job security and financial status “I think 90% of my decision making process is the logical aspect, merely for guaranteed employment and good financial status especially when I see my colleagues from high school struggling to get jobs while they are in the other specialties while someone who’s in the medical field would instantly get the job.” The combination of financial, social (prestigious), lifestyle as well as helping others was also voiced in this investigation. “I always knew I wanted to help people, so that was a big aspect and you know also if I get to help people and make money at the same time that’s awesome”. Other students felt that their choice was not influenced by social or financial reasons, but mainly, it was the idea of having flexible shorter hours “What was in my mind was an easy lifestyle nothing financial and social aspects.”The potential for job security and guaranteed employment also made dentistry an attractive choice for many. “Quite specifically for dentistry, there is job security, so when you graduate, you can find a job easily, so that was a factor also.”
The dentist and how that influences shaping choice was also voiced by several participants “I would go to my orthodontist every two months so I told them I was considering dentistry and he was very enthusiastic about it, and he just kept telling me.” And every time I would go to the clinic after that he was like, “Hey my future colleague.” So, yeah, that was really nice.” An interlay of influences was also visible in some of the comments that students made. “So, definitely family, economic aspect of course, is important and can’t be denied for sure and I guess personally as well because I also wanted to help people somehow”. However, there was also a sense of regret and dissatisfaction. “It was chosen for me, but I’m trying to convince myself that maybe the financial status will be rewarded later on.”
Theme 2: Confidence in the choice made
There was some doubt among some students, in how confident in their choice, particularly among those still at the basic sciences and preclinical years. “I still don’t know, I’m still in the academic year, so I don’t know if I made a good choice.” Perhaps not entering or starting the dental curriculum early may have increased the lack of confidence in the choice of dentistry as a career. “I really don’t know if I made the correct choice or not because we are still medical students, at this stage I would call myself a medical student, I have no exposure to dentistry at all, so, I don’t know if I made the right choice.” What is also emerging among some students, that there was acceptance rather than confidence in choice, or indeed lack of confidence in the choice made. After studying with medicine for four years; some felt maybe they should have continued with medicine and completed medicine instead. “Even now after four years I think it will be hard for us to let go off all this information, all this knowledge that we have acquired, it will all be somewhat useless. So, I think this whole situation is bad because we are getting attached to medicine and then having to let it go and do dentistry after four years.”
It seems that students were more confident in their choice as they moved passed the preclinical years. “Yeah I love it I like drilling apparently and even more today because we’re also shadowing 7th year. This might be a testament to early patient contact, even at the level of shadowing. “I think the CDC (Comprehensive Dental Care) is like the best thing they could ever come up with. The things I learned; we’ve only been there three times, and I feel like I’ve learned more than from any other lecture that we’ve taken.” There were students who were happy with having to learn their preclinical years similar to medicine and felt that this strengthened their learning. “I also want to mention I still enjoy learning just general medical knowledge because I don’t know I’ve always been fascinated by that. So, getting to do both of these things even if the exams are hard and I’m stressed out and sometimes, I really just enjoy the whole science of medicine in general.”
Several students experienced some difficulty in negotiating the thought process if they were confident about their choice. “I think dental students have biased judgments because you know that you’re already accepted into dentistry. There’s no way that we change that so we’ve tried to convince ourselves more that dentistry is better than medicine. So, if we had some dental experience during the first four years, I think our judgment might be different.”
The 6th year, in particular, had a significant number among them who were not confident about their choice. For this particular batch, at entry, the regulations changed; as a result, many students who wanted to do medicine ended up in dentistry. The dental school entry traditionally required the highest GPA, particularly compared to medicine; for this batch, it was the other way round. While they enjoyed the preclinical years, they felt resentful being in this position compared to their counterparts “I think I made the wrong career choice because the dental career is so stressful. I thought it was an easier lifestyle to take, but I regret it, it’s not.” “No, it wasn’t for me, and I regret my choice, I should have defended my opinion back in that time. Dentistry doesn’t fit me in all the aspects, doesn’t fit my personality, and I really regret it.” One student expressed clear resentment “No, I don’t think that it’s the correct decision; I feel if I were in medicine, I would have been doing better than now.” Stronger feeling of regret was to the extent that given the choice again, they will not choose dentistry. “I would go to medicine.” “I would go to medicine if I was allowed to shift after the 4th year.”
The thought process regarding their choice, their culture, family circumstances, and career aspiration, the thought process of weighing all potential career options, an interesting picture emerged. They feel that compared to career choices globally, the choices were limited to this cohort. “I don’t think we have that many options to begin with of what we are going to do, engineering or medicine and it’s like choosing which one you would rather have, it’s like choosing you don’t have that many options, and they give you two options, and you pick the one that you think is least bad.”
Theme 3: Awareness of the program of study and choice:
The current method of selection and the length of study dentistry were clear as to how students feel about their choice. In weighing the options, the students narrative reflected one of two options, whether to study at home in Kuwait or to go to another country (the USA or Europe) to do dentistry. “Yeah, I weighted between Kuwait and US, because my elder brother studied there, so, I thought that maybe I could go study with them or I could stay here in Kuwait, I had my two options open for me.” The reason seems to be not knowing enough or having clear career advice regarding the study of dentistry. “I didn’t know that we will study pure medicine in the first four years; I didn’t know that it was this difficult actually.”
The students' reflection on the issue of dental curriculum not starting till the end of the 4th year, after completing the Bachelor in Medical Science with medical students, having the same curriculum in Anatomy, physiology, biochemistry, etc.”. Not surprisingly, some felt that they should have been allowed to choose at the stage when they completed the four years rather than earlier. “I think that it would be better if students were able to choose dentistry or medicine after year 4. I think it would be better because they would study and see for the first four years and they would be older also, their thinking would be much more different. So, I think many of the students would change their minds at year 4.” “I totally agree with number 3 I’m really afraid that all the knowledge we gained will go to waste, so I might choose medicine because I feel that I’ve come too far in medicine.”
Many students felt a sense of unfairness, that they have to study 7 years to become dentist, while their counterpart who study abroad would do it in less time and potentially have more time within dentistry than them. “I think seven years are too long for dentistry. Like we see our college graduates from other universities before us, and they get more experience in dentistry because we have four years of medicine. So, we only get three years of dentistry while other students get approximately five years. So, they gain more experience than us, and this upsets me.”
Some had mixed feelings about the length of the seven years curriculum. “I have mixed feelings like I want to start my career earlier and have more experience in what I would be doing in the future yet I’m happy that I gained this medical knowledge that I enjoyed plus I can use it in my daily life plus the bachelor of medical sciences is a bonus for us in which we can continue higher masters or Ph.D. and maybe we can leave the dental field in the future I don’t know.”
The not knowing beforehand of having to study with medicine for four years before starting the dental curriculum has had its tall on some students, consequently regretting their choice. “Me too, I didn’t know how was the process exactly, I just feel like I am wasting my time maybe if I knew, maybe wouldn’t be studying dentistry maybe I would have gone outside anywhere but not here because this is too much.” The curriculum of the four years with medical students is believed by the students to be very detailed for what they are going to end up doing as dentists. “I think the university itself specifically the health sciences are very good, but at the 4 years in terms of dentistry it’s too detailed for a dentist, you should have a background because if anything happens to the patient you can deal with but not to this point, the amount of physiology for example.”
The role of pre-college orientation or career advice seems to be lacking with most of the students, and they did not feel that they were giving enough career advice. “My high school didn’t do orientations or something like that for us, I just searched on the internet and asked a few of my friends, and so they helped me to choose this faculty.” I agree totally with what he said; no one ever mentioned anything about careers when we were in high school.” Many students relied on social media for their search to help choose their career choice. “I think the schools now, they don’t give you an insight in majors you are interested in whether it is subjects or like a visit to a place, for example, this is where social media played a role or like the internet as a general. I looked up; I searched what like being a dentist or a lawyer or any other career path.” In Instagram, I followed some doctors, some dentist especially when I entered this career like I want to know more because in high school, in my 18 years before I entered, I didn’t have any information about dentistry.”
Some schools approach seems to orient their students with a view of specifically going abroad to study. “Yeah, they were like, “Study abroad, and if you are going to be a doctor even if you are going into a medical field, be a doctor and not a dentist.” Rather than that, it was nothing really positive.”
The scenario was more or less similar for both public and private schools in that both provided limited career advice or orientation “I was in a public school, and we didn’t get anyone from any university. So, it was useless impacting my career choice.”
There were also sentiments for the need for curriculum reform. “Somebody should please change the curriculum and remove the first four years seriously like they’re still there if you have to. Yesterday I was at the conference, and I saw that guy, and he was surprised that I studied cardiovascular, and GI and renal and he was, “You studied GI! You studied renal, why you don’t need it.” “I think I agree that it should be re-evaluated.”
The students felt the length of curriculum would have been a deciding factor in their decision or choice, if they were aware of what was involved in studying dentistry in comparison, with other universities. “If I knew that I was going to study such great detail in medicine such as renal or reproduction I maybe wouldn’t have entered dentistry because I’m already studying so much detail in medicine. So, if I knew that beforehand so maybe I would have changed my decision.”