Perception of Dental Students on Gender Preferences in Career Choice, Plans, and Expectations in Dentistry in the Kingdom of Saudi Arabia.

INTRODUCTION: Gender-based preferences are common in dental practice and maybe even more prevalent in academic dentistry. A large number of females have been entering the practice of general dentistry for the past two decades. The present study was done to assess dental students' perception of gender preferences in dentistry using a questionnaire in Saudi Arabia.
MATERIALS AND METHODS: A survey was conducted using a pretested questionnaire among dental interns pursuing their internship at different dental schools in Saudi Arabia. The questionnaires were distributed to 482 interns who were willing to participate in the survey. All the responses were collected, tabulated, and analyzed accordingly using appropriate statistical methods.
RESULTS: Four hundred and eighty-two dental interns (180 males and 302 females) responded to the survey. Most female interns (68%) prefer female patients for their treatments to the opposite gender. Seventy-five percent of the male interns felt more capable than females to handle stress and workload associated with branches such as prosthodontics, surgery, and implantology. 52.1% felt that female students fared well in academics.
CONCLUSION: The present study shows that more females are taking up this profession in the current situation. It also shows that females are as competitive as males in dentistry and that most of the dental interns want to take up postgraduation after completion of the course. Both males and females are given equal working space and respect in this field of dentistry. Copyright:

INTRODUCTION

The elements affecting the selection of a dental profession are essential in recognizing the profession's expectations.[1] Several studies have shown that most undergraduate dental students prefer continuing their dental education by joining specialty programs.[234] This has important suggestions for workforce strengthening organization policy and standards in all nations. The demand for dental care has risen dramatically, and a steady increase in dental graduates' supply is witnessed. Thus, the effective allocation of these dental workforces is an important health policy matter globally, which also needs to consider dentists' current choices and future activities. In the year 1987, the Kingdom of Saudi Arabia (KSA) had three dental schools, and therefore, the total number of dentists was <786 with a dentist-to-population ratio of 1:8906.[5] According to the new statistics for the year 2019 from the Ministry of Health statistics, 26 dental colleges are affiliated with different universities. The total number of licensed dentists practicing in the country is 18,811, with a dentist-to-population ratio of 5.5:10,000.[6]

In KSA, the undergraduate dental program offers a 6-year course, including 1 year of internship. The students need to complete and pass the 1-year preparatory course, and based on the grade point average, they are given choices and/or allotted for different programs, including medicine, dentistry, and other health sciences programs.[789] A survey conducted by Al Dlaigan et al. in the year 2012 reported that 77% of the male and 54% of the female dental graduates pursued and completed a specialty master's program in dentistry.[10] Another study done by Halawany reported that the most preferred specialty among male Saudi dental graduates was oral and maxillofacial surgery, whereas it was restorative and cosmetic dentistry for female dental graduates.[7] The carrier choices for dentistry among dental graduates are determined and influenced by many factors such as social class and status, professional background, income, ability to be independent, respect from family and society, service to the community, artistic nature of the job, and stress-free job compared to other health specialties.[111213141516] However, a population's demographic and cultural attributes are also paramount when predicting inspiration and career choices among dental students.[1718] Saudi Arabia has shown rapid and dramatic improvement in dental education in the last decade. These new social reforms have given tremendous opportunities to all dental students in the Kingdom. These recent government reforms and policies might impact career preferences and future activities among dental students. Thus, this current study was aimed to explore the new trends and perceptions among dental interns regarding gender preferences and future carrier choices in KSA.

MATERIALS AND METHODS

The present study is a questionnaire survey that assessed dental students' perception of gender preferences in career choice, plans, and expectations in dentistry using a questionnaire in Saudi Arabia. The study proposal was submitted for approval, and clearance was obtained from the institutional research and ethics committee. The institutional ethical committee reviewed and approved the study, and permission was taken from the administrations of participants' institutions. Dental interns were informed about the study's need and purpose, and informed consent was obtained from each participant. Confidentiality was ensured for all the participating students.

A pretested and validated questionnaire was designed for recording perceptions and career choice that examined motives and gender differences in dental school, influencing factors for carrier choices, and perceptions of dental students on gender preferences in dentistry in Saudi Arabia. A pilot study was conducted on 40 volunteer dental students to assess the feasibility and calculate the minimum sample size and validity of the prepared questionnaire. The questionnaire was prepared in the English language that initially had 17 items covering two sections. Some modifications were made concerning a few items after the pilot study. The questionnaire was tested for its validity and reliability before the main study. A panel of six experts that included five dental educators and biostatistician evaluated the content and face validity.

The questionnaire, as such, was divided into two parts:

Part I: Contained survey questions on demographic details, institution, and year of study

Part II: The questionnaire distributed concerned to assess factors influencing gender differences and motives in dental schools, determinants of career choices, and perceptions of dental students on gender preferences in dentistry.

The questionnaires were distributed among dental interns across the Kingdom using a combination of convenience and snowball sampling techniques. We received a total of 482 interns' responses who were willing to participate in the survey. The survey was held during faculty hours to maximize the number of students answering the questionnaire.

An independent biostatistician analyzed IBM Statistical Package for the Social Sciences version 23.0 (SPSS Inc., Chicago, IL, USA). Univariate and Bivariate frequency tables were generated. For selected variables, associations were studied between gender and parameters using Pearson's Chi-square test. The significance value was set at P < 0.05 to be considered statistically significant.

RESULTS

A total of 482 dental interns responded to the survey, of which 62.7% (n = 302) were females and 37.3% (n = 180) were males. The mean age of the participants was found to be 23.2 ± 1.24. According to 61.2% of the participants, gender discrimination means “differentiation of male and female in college/profession,” and 37.8% mentioned it as “inequality in social class,” which was comparatively more reported by females (45.4%) and showed a statistically significant association (P < 0.001) [Table 1]. It was found that 73.2% (n = 221) of the females and 51.7% (n = 93) of the males had the opinion that the field of dentistry is not increasingly becoming female-dominated nowadays and this perception showed a statistically significant association (χ2 = 59.900, P < 0.001). The majority of the female interns (68%) preferred to do dental procedures on female patients, whereas 97.7% (n = 176) of the male interns did not have gender preferences in treating patients.

Table 1

Distribution of participants according to their perception of gender discrimination

Gender discrimination means	Total (%)	Male (%)	Female (%)	P*, χ2
Inequality in social class	182 (37.8)	45 (25)	137 (45.4)	<0.001, 24.300
Differentiation of male and female in college/profession	295 (61.2)	135 (75)	160 (53)
None of the above	5 (1)	0	5 (1.7)
Don’t know	0	0	0

*P<0.05 Statistically significant

The interns' responses regarding perception toward specialties showed that 52% preferred clinical branches to nonclinical branches for their postgraduate programs. It was found that 75% of the males felt that they were more capable than females to handle stress and workload associated with branches such as prosthodontics, surgery, and implantology. Oral surgery (19.1%), orthodontics (26.8%), and implantology (10.2%) were the fields that attracted most of them in dentistry. In comparison, 6.6% of them considered operative dentistry, 14.3% for endodontics, and 6.6% for periodontology as their interests, with 6.2% giving preference to pedodontics also. Only very few opted for the nonclinical fields such as oral medicine (3.5%), dental public health (2.7%), and oral pathology (1%) [Table 2].

Table 2

Distribution of participants perception toward the specialties in dentistry

	Total (%)	Male (%)	Female (%)	P*, χ2
Stress and workload associated (prosthodontics, surgery and implantology) handled well by
Male students	221 (45.9)	136 (75.6)	85 (28.1)	<0.001, 103.0
Female students	5 (1)	0	5 (1.7)
No difference	256 (53.1)	44 (24.4)	212 (70.2)
Preferred specialty for postgraduation
Oral medicine	17 (3.5)	0	17 (5.6)	0.023, 128.1
Oral surgery	92 (19.1)	74 (15.4)	18 (3.7)
Pedodontics	30 (6.2)	0	30 (9.9)
Operative dentistry	32 (6.6)	5 (2.8)	27 (8.9)
Endodontics	69 (14.3)	26 (5.4)	43 (8.9)
Prosthodontics	14 (2.9)	9 (5)	5 (1.7)
Periodontics	32 (6.6)	0	32 (10.6)
Implantology	49 (10.2)	0	49 (16.2)
Dental public health	13 (2.7)	9 (5)	4 (1.3)
Oral pathology	5 (1)	0	5 (1.7)
Orthodontics	129 (26.8)	72 (40)	57 (18.9)
In your opinion, the choice of clinical branches is preferred over nonclinical branches for their postgraduate program by
Male students	137 (28.4)	137 (76.1)	0	<0.001, 330.0
Female students	94 (19.5)	0	94 (31.1)
No difference	251 (52.1)	43 (23.9)	208 (68.9)

*a P value <0.05 is considered statistically significant

The analysis showed that 46.7% considered that it was the prestige of being called a doctor that made them pursue a career in dentistry, and 55% said that the most rewarding aspect of this profession was the respect they got from it. It was reported by 57.9% that this profession is interesting, but only 10.6% of them worked in a clinic after college, and 56% of them wanted to do a postgraduate program soon after completion of the course, whereas only 20.5% had the plan to set up a private clinic immediately after graduation [Table 3].

Table 3

Distribution of participants’ perception about their profession

	Total (%)	Male (%)	Female (%)	P* value, χ2
First reason for choosing dentistry
Working with people	41 (8.5)	36 (20)	5 (1.7)	0.021, 123.19
Financial gains	64 (13.3)	5 (2.8)	59 (19.5)
Flexible working hours	60 (12.4)	32 (17.8)	28 (9.3)
Opportunity for self-employment	11 (2.3)	10 (5.6)	1 (0.3)
Prestige of being called a doctor	225 (46.7)	92 (51.1)	133 (44)
Others	81 (16.8)	5 (2.8)	76 (25.2)
Most rewarding aspect of dentistry
Professional standing	86 (17.8)	11 (6.1)	75 (24.8)	<0.001, 112.00
Respect for the profession	264 (54.8)	154 (85.6)	110 (36.4)
Financial security	63 (13.1)	5 (2.8)	58 (19.2)
Flexible working hours	69 (14.3)	10 (5.6)	59 (19.5)

*a P value <0.05 is considered statistically significant

DISCUSSION

Gender-based preferences are common in dental practice and maybe even more prevalent in academic dentistry. The study's findings showed that 62% of the respondents were females, which is evidence that more females are taking up this profession in this present situation in the KSA. In the USA, a study done by Scarbecz and Ross reported that 38% of the undergraduate dental students are females, and also 18% of the females are active dental practitioners.[19] A study done by Nahid et al. reported an increase in the percentage of female dental graduates from 3.6% to 11.4% between 1983 and 2006 in one of the dental colleges in Riyadh city.[20] This particular profession format provides unique contingencies and opportunities irrespective of gender to discharge a high degree of freedom, sovereignty, and buoyancy and also at the same time enjoy high social status associated with being a health-care professional. Over the past 20 years, the dental profession has witnessed a rapid increase in female dentists, and this noticeable demographic trend is a matter of concern for health policymakers. The current trend shows that female dentists are increasing irrespective of geographic distribution also.[21] Shreds of evidence show that the number of females opting for health sciences has increased. This progression is much evident in dentistry, and there is an expanding pool of female applicants seen for dental bachelor degree admissions.[2223] In Saudi Arabia, there has been a dramatic progress seen in the health-care sector. Females have been progressing to top leadership positions and broke traditional obstacles for gender inequalities by setting standards for future generations.[24]

In this study, 52% of the interns believed that they equal opinions about whether clinical branches were preferred over nonclinical branches for their postgraduate studies. Orthodontics (26.8%), oral surgery (19.3%), and implantology (10.2%) were the fields that attracted most of them in dentistry. A study done by Halawany et al. in the year 2017 has reported that operative and cosmetic dentistry was the most preferred specialty, followed by endodontics, prosthodontics, and orthodontics.[25] The main reason for choosing a specialization, as reported by students, is that it is more rewarding, and specialists earn higher than general dentists.[19] Another study reported that female dentists prefer to work in the public sector than male dentists, which could be due to the more secure nature of the job than the private sector.[26] In this study, comparatively, males preferred specialties oral surgery and orthodontics. In contrast, females opted for pedoodntics, oral medicine, and periodontics more than males. This finding is similar to two other studies done in Saudi Arabia.[710] It is also reported that females showed greater interest than males in pursuing higher qualifications, but the actual percentage of females taking up postgraduation was less than males.[23] In a similar survey done by Nahid et al., it was reported that there were no significant differences in the gender ratio of dentists that obtained postgraduate programs such as a master's degree or Ph.D.[20] It has been argued that female dentists are more likely to interrupt their careers more often and for more extended periods than their male colleagues. It has also been reported by Riley et al. that male dentists obtain additional postgraduation and degrees more and at a rapid pace than their counterparts.[27]

The current study findings provided an understanding of future practice preferences and thought on carrier profiles among dental interns in KSA. Our study's findings showed that there were no major differences in opinion between male and female dental interns regarding gender preferences and inequalities in job opportunities and working hours. Studies done in Western countries have shown that there were no major differences exhibited in female dentists' working patterns compared to male dentists until they are married and have children but showed a reduction in working hours among females once they have children of young ages. Female dentists were influenced by the conflict of balancing their professional careers with the competing responsibilities of family life, homemaking, child rearing, and financial demands.[2022] The differences in biological and social characters between men and women are unavoidable and sometimes very difficult to modify. Reports from the Kingdom show that female dentists working in the government sectors were usually given lower title positions in the employment hierarchies and are comparatively given lower salaries than their counterparts.[2022] The advancement in health-care sectors, research, and academics needs equal support from males and females. Unless practices, attitudes, and relations of the society change, policies to promote gender equality will face an uphill struggle. If we are to make real progress toward achieving gender equality, we must support women to challenge these strict gender divisions. Initiatives need to engage men and women as allies at home, at work, and in the community, using positive and relevant messages addressing the specific concern of gender equality.

CONCLUSION

The present study results show that more females are taking up this profession in the present situation. It also shows that females are as competitive as males in dentistry and that most of the dental interns want to take up postgraduation after completion of the course. Both males and females are given equal working space and respect in this field of dentistry. Researchers need to focus on gender inequalities in health-care professions, and there is a need to acquire new data related to current trends in carrier choices, gender biases, salaries, promotions, responsibilities, and mentoring in the field of dentistry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.