Public Health Section DOI : 10.7860/JCDR/2020/43275.13514
Year : 2020 | Month : Feb | Volume : 14 | Issue : 02 Page : LC10 - LC16

Stress among Clinical Dental Students in a Private Dental College in Jeddah

Othman Wali1, Kavita Marusamy2, Amit Vanka3, Shanthi Vanka4

1 Vice Dean, Department of Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia.
2 Assistant Professor, Department of Preventive Dental Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia.
3 Associate Professor, Department of Preventive Dental Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia.
4 Lecturer, Department of Preventive Dental Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia.


NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Shanthi Vanka, Ibn Sina National College, Al Safa Dist Al Mahjar St, Jeddah, Makkah, Saudi Arabia.
E-mail: shanthiamit@rediffmail.com
Abstract

Introduction

Environment in many dental colleges is highly competitive and stressful. Stress of students has two main factors personality-oriented and work/study-oriented.

Aim

To assess the factors responsible for stress among the dental students in a private dental college.

Materials and Methods

The cross-divtional study population included the students of dentistry program who were from fourth year to sixth year which are clinical years and students spend most of their time in the dental clinic. To investigate relevance and influence of the factors on stress experienced by students in the clinical years, a questionnaire was designed. The questionnaire has been tested for its validity and reliability based on a pilot study and pre-survey discussions with peers in the college. The association of the responses of the students to factors associated with stress was calculated using chi-square test. The data were analysed using Statistical Package for Social Sciences (SPSS) version 23.0.

Results

The responses of the students have been analysed, 64% of the students do feel that they are stressed during exams. A 52% students strongly agreed that the amount of work assigned was more. A 22% students agree that they lack the confidence of being a successful dental student. More than half of the students (71%) have lack of time for relaxation. The p-value of <0.05 was considered as statistically significant.

Conclusion

This is an important study as dental students of Jeddah, are under tremendous amount of stress which is due to their own personality traits or created by environment.

Introduction

Dental curriculum has varied domains of learning which includes skills in knowledge, cognition, interpersonal skills and psychomotor skills [1,2]. Dental students are subjected to undue stress if they don’t have a healthy environment in the dental institution, if they lack confidence in themselves, lack of faith in faculty, facilities available such as laboratories, clinics, library, attached hospital and so on Stress can result in physical and psychological distress, which affect the performance of the students, causing anxiety, depression, phobia, fear, tension dizziness, fatigue etc., [3]. Stress may be caused due to the discrepancy between the demands of the dental curriculum and the capacity of the students to fulfil all the requirements to complete the program and get the dental degree [4]. The author perceives from the literature review that the students don’t set goals to complete the requirements of the program and if they have set clear goals, they do not monitor task completion as per the allotted time [5].

Thus the objective of the present study is to assess the factors responsible for stress among the dental students in a private dental college.

Materials and Methods

The Dentistry curriculum in Saudi Arabia is for seven years inclusive of one year of internship. This cross-sectional study included the students of dentistry program from fourth year to sixth year, age 19 to 25 years and was conducted in March 2018. Ethical approval was granted for the study from the Ethical Committee of Ibn Sina National College for Medical Studies. All the students from 4th to 6th year registered to Dentistry program, available on the day of questionnaire distribution were included in the study. Consent was taken from all the participants and it was informed that confidentiality of the data would be maintained.

The questionnaire has been tested for its validity and reliability based on a pilot study and pre-survey discussions with peers in the institution. The questionnaire was translated into Arabic for pilot and the main study. It has been validated by a pilot study that was conducted on a sample of 30 students. The linguistic validity was assessed as content validity and all the questions included in the questionnaire have yielded a positive value from all the reviewers. The cronbach alpha value for the validity of the questionnaire was 0.8. The questionnaire was distributed to the students in their break time so that they could get sufficient time to fill the questionnaire. The questionnaire was collected back from the students in the form of a hard copy.

A 40 item questionnaire was prepared from the various factors causing stress among students, from the literature review and was used to collect data for the study [1-4]. All the students from 4th to 6th year students in the institute were the inclusion for the study. All the preclinical year students and the students of other programs like medicine, pharmacy and nursing were the exclusion for the study. The questionnaire contained questions that throw light on factors to investigate the relevance and influence on stress experienced by students in the clinical years. The author observed and included all the points described below that the students in the clinical years feel stress.

The questionnaire included reasons of stress being the students inability to complete the assignments regularly within the time allocated, competition with peers, fear of failing a course or the year, difficulty in understanding lectures, lack of confidence to be the successful dental student, language barrier with the patients, lack of time for relaxation, rules and regulations set by the faculty, unapproachability of the teaching staff, inability to catch up if getting behind work, lack of confidence to be a successful dentist, financial resources, personal problems, language barrier with teaching staff, difficulty in understanding literature, working on patients with dirty mouths and fear of getting infectious diseases, lack of cooperation from patients, lack of confidence in clinical decision making, difficulty in learning clinical procedures, availability of supervisors, lab technicians, lack of calibration among staff and inconsistency of feedback regarding work, responsibility to do a comprehensive patient care, difficult cases for the clinical exam and having a fully loaded day.

This study was conducted on the students attending the clinical years of study in the Dentistry program, Ibn Sina National College. There were 300 questionnaires distributed to the students in clinical years. The total sample of students who participated in the survey was 273. The power of study was considered to be 80%.

Statistical Analysis

The data were analysed using SPSS (statistical package for social sciences) version 23.0. The association of the responses of the students to factors associated with stress was calculated using chi-square test and p-value <0.05 was considered statistically significant.

Results

The mean age of the participants was 22 years. The gender and academic year distribution of the participants has been explained in [Table/Fig-1].

The mean of gender and academic year distribution of the participants.

Academic yearMaleFemaleTotal
4th yearNumber3580115
Percentage30.4%69.6%100.0%
5th yearNumber394584
Percentage46.4%53.6%100.0%
6th yearNumber175774
Percentage23.0%77.0%100.0%
TotalNumber91182273
Percentage33.3%66.7%100.0%

The responses of the students have been collected and analysed using the chi-square test and the results have been discussed below. The factors that have statistically been proved significant after applying chi-square test in which the p-value was <0.05 have been star marked in [Table/Fig-2,3]. As summarised in [Table/Fig-2,3], majority of the students that is nearly 90% have a feeling that the amount of work assigned to them is more. A 54% of the students feel the competition with peers for getting good grades.

The responses of 4th, 5th and 6th year BDS students on stress from question no.1-20.

Strongly agree n (%)Agree n (%)True sometimes n (%)Disagree n (%)Strongly disagree n (%)p-value after chi-square test
1.I feel that the amount of assigned work is more0.237
4th year BDS54 (47.0%)32 (27.8%)16 (13.9%)11 (9.6%)2 (1.7%)
5th year BDS48 (57.1%)17 (20.2%)13 (15.5%)5 (6.0%)1 (1.2%)
6th year BDS40 (54.1%)15 (20.3%)5 (6.8%)8 (10.8%)6 (8.1%)
Total142 (52.0%)64 (23.4%)34 (12.5%)24 (8.8%)9 (3.3%)
2.I feel the competition with peers for getting good grades0.096
4th year BDS22 (19.1%)36 (31.3%)35 (30.4%)16 (13.9%)6 (5.2%)
5th year BDS27 (32.1%)23 (27.4%)18 (21.4%)9 (10.7%)7 (8.3%)
6th year BDS12 (16.2%)28 (37.8%)17 (23.0%)13 (17.6%)4 (5.4%)
Total61 (22.3%)87 (31.9%)70 (25.6%)38 (13.9%)17 (6.2%)
3.I feel stressed during examinations*0.019
4th year BDS71 (61.7%)24 (20.9%)10 (8.7%)8 (7.0%)2 (1.7%)
5th year BDS66 (78.6%)6 (7.1%)7 (8.3%)3 (3.6%)2 (2.4%)
6th year BDS38 (51.4%)19 (25.7%)8 (10.8%)4 (5.4%)5 (6.8%)
Total175 (64.1%)49 (17.9%)25 (9.2%)15 (5.5%)9 (3.3%)
4.I have difficulty in understanding lectures0.663
4th year BDS10 (8.7%)29 (25.2%)55 (47.8%)19 (16.5%)2 (1.7%)
5th year BDS10 (11.9%)21 (25.0%)36 (42.9%)13 (15.5%)4 (4.8%)
6th year BDS5 (6.8%)20 (27.0%)28 (37.8%)18 (24.3%)3 (4.1%)
Total25 (9.2%)70 (25.6%)119 (43.6%)50 (18.3%)9 (3.3%)
5.I have lack of confidence to be a successful dental student0.652
4th year BDS17 (14.8%)12 (10.4%)20 (17.4%)31 (27.0%)35 (30.4%)
5th year BDS9 (10.7%)12 (14.3%)21 (25.0%)18 (21.4%)24 (28.6%)
6th year BDS8 (10.8%)6 (8.1%)12 (16.2%)22 (29.7%)26 (35.1%)
Total34 (12.5%)30 (11.0%)53 (19.4%)71 (26.0%)85 (31.1%)
6.Having lack of confidence to be a successful dentist0.419
4th year BDS16 (13.9%)11 (9.6%)20 (17.4%)39 (33.9%)29 (25.2%)
5th year BDS7 (8.3%)7 (8.3%)15 (17.9%)21 (25.0%)34 (40.5%)
6th year BDS5 (6.8%)7 (9.5%)13 (17.6%)21 (28.4%)28 (37.8%)
Total28(10.3%)25 (9.2%)48 (17.6%)81 (29.7%)91 (33.3%)
7.Having lack of time for relaxation0.170
4th year BDS50 (43.5%)27 (23.5%)26 (22.6%)7 (6.1%)5 (4.3%)
5th year BDS50 (59.5%)17 (20.2%)7 (8.3%)5 (6.0%)5 (6.0%)
6th year BDS33 (44.6%)17 (23.0%)11 (14.9%)8 (10.8%)5 (6.8%)
Total133 (48.7%)61 (22.3%)44 (16.1%)20 (7.3%)15 (5.5%)
8.I have a fear of failing a course or the year0.079
4th year BDS31 (27.2%)17 (14.9%)40 (35.1%)14 (12.3%)12 (10.5%)
5th year BDS27 (32.1%)21 (25.0%)22 (26.2%)8 (9.5%)6 (7.1%)
6th year BDS14 (18.9%)9 (12.2%)27 (36.5%)10 (13.5%)14 (18.9%)
Total72 (26.5%)47 (17.3%)89 (32.7%)32 (11.8%)32 (11.8%)
9.The rules and regulations of the faculty are difficult*0.006
4th year BDS32 (27.8%)35 (30.4%)35 (30.4%)9 (7.8%)4 (3.5%)
5th year BDS50 (59.5%)16 (19.0%)13 (15.5%)4 (4.8%)1 (1.2%)
6th year BDS28 (37.8%)21 (28.4%)17 (23.0%)5 (6.8%)3 (4.1%)
Total110 (40.3%)72 (26.4%)65 (23.8%)18 (6.6%)8 (2.9%)
10.I fear of not having possibility to pursue a postgraduate program0.272
4th year BDS28 (24.3%)25 (21.7%)35 (30.4%)17 (14.8%)10 (8.7%)
5th year BDS20 (23.8%)19 (22.6%)23 (27.4%)15 (17.9%)7 (8.3%)
6th year BDS19 (25.7%)17 (23.0%)18 (24.3%)13 (17.6%)7 (9.5%)
Total67 (24.5%)61 (22.3%)76 (27.8%)45 (16.5%)24 (8.8%)
11.Un approachability of the teaching staff0.997
4th year BDS31 (27.0%)28 (24.3%)31 (27.0%)18 (15.7%)7 (6.1%)
5th year BDS26 (31.0%)17 (20.2%)28 (33.3%)9 (10.7%)4 (4.8%)
6th year BDS29 (39.2%)16 (21.6%)14 (18.9%)8 (10.8%)7 (9.5%)
Total86 (31.5%)61 (22.3%)73 (26.7%)35 (12.8%)18 (6.6%)
12.I have fear of being unable to catch up if getting behind with work*0.003
4th year BDS35 (30.4%)34 (29.6%)24 (20.9%)13 (11.3%)9 (7.8%)
5th year BDS42 (50.0%)11 (13.1%)22 (26.2%)6 (7.1%)3 (3.6%)
6th year BDS17 (23.0%)17 (23.0%)18 (24.3%)15 (20.3%)7 (9.5%)
Total94 (34.4%)62 (22.7%)64 (23.4%)34 (12.5%)19 (7.0%)
13.I have fear of unemployment after graduation0.215
4th year BDS40 (34.8%)23 (20.0%)23 (20.0%)19 (16.5%)10 (8.7%)
5th year BDS26 (31.0%)19 (22.6%)20 (23.8%)9 (10.7%)10 (11.9%)
6th year BDS21 (28.4%)16 (21.6%)17 (23.0%)11 (14.9%)9 (12.2%)
Total87 (31.9%)58 (21.2%)60 (22.0%)39 (14.3%)29 (10.6%)
14.I have difficulty in managing my financial resources0.934
4th year BDS31 (27.0%)22 (19.1%)29 (25.2%)20 (17.4%)13 (11.3%)
5th year BDS25 (29.8%)15 (17.9%)23 (27.4%)15 (17.9%)6 (7.1%)
6th year BDS14 (18.9%)17 (23.0%)17 (23.0%)14 (18.9%)12 (16.2%)
Total70 (25.6%)54 (19.8%)69 (25.3%)49 (17.9%)31 (11.4%)
15.My marriage or engagement is postponed because of studies0.679
4th year BDS30 (26.1%)17 (14.8%)20 (17.4%)16 (13.9%)32 (27.8%)
5th year BDS30(35.7%)16(19.0%)11(13.1%)12(14.3%)15(17.9%)
6th year BDS16 (21.6%)13 (17.6%)14 (18.9%)13 (17.6%)18 (24.3%)
Total76 (27.8%)46 (16.8%)45 (16.5%)41 (15.0%)65 (23.8%)
16.Necessity to postpone having children0.540
4th year BDS35 (30.4%)27 (23.5%)26 (22.6%)9 (7.8%)18 (15.7%)
5th year BDS34 (40.5%)20 (23.8%)12 (14.3%)9 (10.7%)9 (10.7%)
6th year BDS28 (37.8%)15 (20.3%)13 (17.6%)7 (9.5%)11 (14.9%)
Total97 (35.5%)62 (22.7%)51 (18.7%)25 (9.2%)38 (13.9%)
17.Having dual role of wife/mother/father/dental student is difficult0.754
4th year BDS31 (27.0%)22 (19.1%)34 (29.6%)14 (12.2%)14 (12.2%)
5th year BDS42 (50.0%)15 (17.9%)12 (14.3%)5 (6.0%)10 (11.9%)
6th year BDS28 (37.8%)15 (20.3%)16 (21.6%)6 (8.1%)9 (12.2%)
Total101 (37.0%)52 (19.0%)62 (22.7%)25 (9.2%)33 (12.1%)
18.My personal physical health is affected0.074
4th year BDS37 (32.2%)30 (26.1%)34 (29.6%)6 (5.2%)8 (7.0%)
5th year BDS45 (53.6%)15 (17.9%)15 (17.9%)5 (6.0%)4 (4.8%)
6th year BDS26 (35.1%)19 (25.7%)19 (25.7%)3 (4.1%)7 (9.5%)
Total108 (39.6%)64 (23.4%)68 (24.9%)14 (5.1%)19 (7.0%)
19.Distance and time needed to travel dental college0.153
4th year BDS43 (37.4%)34 (29.6%)21 (18.3%)8 (7.0%)9 (7.8%)
5th year BDS39 (46.4%)9 (10.7%)26 (31.0%)5 (6.0%)5 (6.0%)
6th year BDS30 (40.5%)17 (23.0%)14 (18.9%)6 (8.1%)7 (9.5%)
Total112 (41.0%)60 (22.0%)61 (22.3%)19 (7.0%)21 (7.7%)
20.I have language barrier with teaching staff*0.034
4th year BDS20 (17.4%)23 (20.0%)41 (35.7%)15 (13.0%)16 (13.9%)
5th year BDS20 (23.8%)18 (21.4%)19 (22.6%)18 (21.4%)9 (10.7%)
6th year BDS13 (17.6%)14 (18.9%)18 (24.3%)8 (10.8%)21 (28.4%)
Total53 (19.4%)55 (20.1%)78 (28.6%)41 (15.0%)46 (16.8%)

The responses of 4th, 5th and 6th year BDS students on stress from question no. 21-40.

21.I have difficulty in understanding literature0.510
4th year BDS18 (15.7%)23 (20.0%)46 (40.0%)16 (13.9%)12 (10.4%)
5th year BDS12 (14.3%)20 (23.8%)35 (41.7%)15 (17.9%)2 (2.4%)
6th year BDS10 (13.5%)12 (16.2%)28 (37.8%)11 (14.9%)13 (17.6%)
Total40 (14.7%)55 (20.1%)109 (39.9%)42 (15.4%)27 (9.9%)
22.Working on patients with dirty mouths0.087
4th year BDS29 (25.2%)23 (20.0%)32 (27.8%)15 (13.0%)16 (13.9%)
5th year BDS32(38.1%)14 (16.7%)20 (23.8%)11 (13.1%)7 (8.3%)
6th year BDS16 (21.6%)16 (21.6%)12 (16.2%)15 (20.3%)15 (20.3%)
Total77 (28.2%)53 (19.4%)64 (23.4%)41 (15.0%)38 (13.9%)
23.I have lack of confidence in clinical decision making0.192
4th year BDS19 (16.5%)14 (12.2%)44 (38.3%)26 (22.6%)12 (10.4%)
5th year BDS12 (14.3%)13 (15.5%)31 (36.9%)17 (20.2%)10 (11.9%)
6th year BDS8 (10.8%)8 (10.8%)22 (29.7%)21 (28.4%)15 (20.3%)
Total39 (14.3%)35 (12.8%)97 (35.5%)64 (23.4%)37 (13.6%)
24.I have difficulty in completing of clinical requirements0.098
4th year BDS20 (17.4%)20 (17.4%)42 (36.5%)20 (17.4%)13 (11.3%)
5th year BDS23 (27.4%)17 (20.2%)22 (26.2%)16 (19.0%)6 (7.1%)
6th year BDS15 (20.3%)11 (14.9%)22 (29.7%)13 (17.6%)13 (17.6%)
Total58 (21.2%)48 (17.6%)86 (31.5%)49 (17.9%)32 (11.7%)
25.I am receiving criticism from staff in clinical work0.474
4th year BDS14 (12.2%)17 (14.8%)41 (35.7%)27 (23.5%)16 (13.9%)
5th year BDS18 (21.4%)11 (13.1%)32 (38.1%)19 (22.6%)4 (4.8%)
6th year BDS10 (13.5%)10 (13.5%)24 (32.4%)16 (21.6%)14 (18.9%)
Total42 (15.4%)38 (13.9%)97 (35.5%)62 (22.7%)34 (12.5%)
26.I feel distressed when patients being late or not showing for their appointments0.388
4th year BDS71 (61.7%)15 (13.0%)15 (13.0%)7 (6.1%)7 (6.1%)
5th year BDS65 (77.4%)6 (7.1%)10 (11.9%)2 (2.4%)1 (1.2%)
6th year BDS44 (59.5%)10 (13.5%)11 (14.9%)5 (6.8%)4 (5.4%)
Total180 (65.9%)31 (11.4%)36 (13.2%)14 (5.1%)12 (4.4%)
27.I have difficulty in learning clinical procedures0.255
4th year BDS21 (18.3%)20 (17.4%)33 (28.7%)30 (26.1%)11 (9.6%)
5th year BDS17 (20.2%)15 (17.9%)27 (32.1%)18 (21.4%)7 (8.3%)
6th year BDS12 (16.2%)14 (18.9%)10 (13.5%)22 (29.7%)16 (21.6%)
Total50 (18.3%)49 (17.9%)70 (25.6%)70 (25.6%)34 (12.5%)
28.I hate the atmosphere created by clinical supervisors0.316
4th year BDS36 (31.3%)24 (20.9%)41 (35.7%)11 (9.6%)3 (2.6%)
5th year BDS37 (44.0%)19 (22.6%)14 (16.7%)9 (10.7%)5 (6.0%)
6th year BDS27 (36.5%)15 (20.3%)20 (27.0%)6 (8.1%)6 (8.1%)
Total100 (36.6%)58 (21.2%)75 (27.5%)26 (9.5%)14 (5.1%)
29.There is lack availability of supervisors in clinic0.071
4th year BDS59 (51.3%)21 (18.3%)18 (15.7%)10 (8.7%)7 (6.1%)
5th year BDS35 (41.7%)23 (27.4%)17 (20.2%)5 (6.0%)4 (4.8%)
6th year BDS30 (40.5%)20 (27.0%)14 (18.9%)6 (8.1%)4 (5.4%)
Total124 (45.4%)64 (23.4%)49 (17.9%)21 (7.7%)15 (5.5%)
30.I have shortage of allocated clinical time0.163
4th year BDS56 (48.7%)23 (20.0%)23 (20.0%)2 (1.7%)11 (9.6%)
5th year BDS40 (48.2%)20 (24.1%)11 (13.3%)8 (9.6%)4 (4.8%)
6th year BDS29 (39.2%)22 (29.7%)13 (17.6%)7 (9.5%)3 (4.1%)
Total125 (46.0%)65 (23.9%)47 (17.3%)17 (6.2%)18 (6.6%)
31.I have language barrier with patients0.749
4th year BDS16 (13.9%)15 (13.0%)33 (28.7%)22 (19.1%)29 (25.2%)
5th year BDS16 (19.0%)9 ()10.7%25 (29.8%)24 (28.6%)10 (11.9%)
6th year BDS10 (13.5%)12 (16.2%)17 (23.0%)16 (21.6%)19 (25.7%)
Total42 (15.4%)36 (13.2%)75 (27.5%)62 (22.7%)58 (21.2%)
32.Availability of lab technicians is in shortage0.105
4th year BDS57 (49.6%)16 (13.9%)15 (13.0%)17 (14.8%)10 (8.7%)
5th year BDS46 (54.8%)16 (19.0%)9 (10.7%)9 (10.7%)4 (4.8%)
6th year BDS45 (60.8%)11 (14.9%)10 (13.5%)4 (5.4%)4 (5.4%)
Total148 (54.2%)43 (15.8%)34 (12.5%)30 (11.0%)18 (6.6%)
33.Differences in opinion between clinical staff concerning patient treatment0.288
4th year BDS49 (42.6%)22 (19.1%)26 (22.6%)8 (7.0%)10 (8.7%)
5th year BDS32 (38.1%)20 (23.8%)22 (26.2%)5 (6.0%)5 (6.0%)
6th year BDS32 (43.2%)16 (21.6%)17 (23.0%)6 (8.1%)3 (4.1%)
Total113 (41.4%)58 (21.2%)65 (23.8%)19 (7.0%)18 (6.6%)
34.Getting an ideal case for clinical examination is difficult0.516
4th year BDS42 (36.5%)21 (18.3%)37 (32.2%)8 (7.0%)7 (6.1%)
5th year BDS39 (46.4%)17 (20.2%)21 (25.0%)3 (3.6%)4 (4.8%)
6th year BDS32 (43.2%)19 (25.7%)10 (13.5%)6 (8.1%)7 (9.5%)
Total113 (41.4%)57 (20.9%)68 (24.9%)17 (6.2%)18 (6.6%)
35.I have a fear of facing parents after failure0.939
4th year BDS27 (23.5%)16 (13.9%)35 (30.4%)22 (19.1%)15 (13.0%)
5th year BDS23 (27.4%)10 (11.9%)24 (28.6%)19 (22.6%)8 (9.5%)
6th year BDS11 (14.9%)9 (12.2%)20 (27.0%)20 (27.0%)14 (18.9%)
Total61 (22.3%)35 (12.8%)79 (28.9%)61 (22.3%)37 (13.6%)
36.Lack of cooperation by patients in their home care0.170
4th year BDS41 (35.7%)29 (25.2%)32 (27.8%)9 (7.8%)4 (3.5%)
5th year BDS31 (36.9%)24 (28.6%)20 (23.8%)5 (6.0%)4 (4.8%)
6th year BDS26 (35.1%)23 (31.1%)11 (14.9%)9 (12.2%)5 (6.8%)
Total98 (35.9%)76 (27.8%)63 (23.1%)23 (8.4%)13 (4.8%)
37.I have a full loaded day*0.016
4th year BDS66 (57.4%)26 (22.6%)13 (11.3%)4 (3.5%)6 (5.2%)
5th year BDS62 (73.8%)8 (9.5%)11 (13.1%)3 (3.6%)0 (0.0%)
6th year BDS41 (55.4%)17 (23.0%)5 (6.8%)3 (4.1%)8(10.8%)
Total169 (61.9%)51 (18.7%)29 (10.6%)10 (3.7%)14 (5.1%)
38.I have more responsibilities for comprehensive patient care0.525
4th year BDS44 (38.3%)29 (25.2%)24 (20.9%)10 (8.7%)8 (7.0%)
5th year BDS34 (40.5%)19 (22.6%)25 (29.8%)5 (6.0%)1 (1.2%)
6th year BDS32 (43.2%)24 (32.4%)8 (10.8%)6 (8.1%)4 (5.4%)
Total110 (40.3%)72 (26.4%)57 (20.9%)21 (7.7%)13 (4.8%)
39.I fear of getting infectious diseases0.556
4th year BDS70 (60.9%)22 (19.1%)12 (10.4%)6 (5.2%)5 (4.3%)
5th year BDS60 (71.4%)9 (10.7%)7 (8.3%)8 (9.5%)0 (0.0%)
6th year BDS40 (54.1%)16 (21.6%)10 (13.5%)3 (4.1%)5 (6.8%)
Total170 (62.3%)47 (17.2%)29 (10.6%)17 (6.2%)10 (3.7%)
40.Inconsistency of feedback regarding my work0.128
4th year BDS55 (47.8%)20 (17.4%)22 (19.1%)12 (10.4%)6 (5.2%)
5th year BDS52 (61.9%)13 (15.5%)10 (11.9%)6 (7.1%)3 (3.6%)
6th year BDS30 (40.5%)18 (24.3%)13 (17.6%)8 (10.8%)5 (6.8%)
Total137 (50.2%)51 (18.7%)45 (16.5%)26 (10%)14 (10%)

*Variables are statistically significant with p<0.05


Almost 80% of the students are finding difficulty in understanding the lectures and 12% students strongly agree that they lack the confidence of being a successful dentist.

More than half of the students have lack of time for relaxation (71%). An amount of 27% of the students strongly agree that they have a fear of failing a course or the year. Nearly 50% of the students agree that they have a fear of possibility to pursue a postgraduate program. About 80% of the respondents do feel that the teaching staff are unapproachable.

A total of 46% of the students were having difficulty in managing their financial resources. Nearly, 50% of the students responded that personal issues like engagement, marriage, roles to play as a wife/mother/father/dental student were the possible reasons for stress. A total of 63% of the students responded that health and distance and time needed to travel to the dental college was a cause of stress.

There were 36%, 27% and 39% of the respondents strongly agree and agree that learning clinical procedures, lack of confidence in clinical decision making and difficulty in completing requirements were a cause of stress. Nearly, 65% of the respondents strongly agree, agree and find it true sometimes that criticism from staff was a cause of stress. Lack of availability of the supervisors and not comfortable with the atmosphere created by them in the clinic were a cause of stress as agreed by 69% and 57%, respectively. A total of 46% strongly agree, 23.9% agree, 17.3% say true sometimes, 6.2% disagree and 6.6% strongly disagree that there was a shortage in the allocated clinical time and was a cause of stress. Faculty not being calibrated in their opinion between patient treatment options was a cause of stress as per 62% of the participants. Almost the same 62% also agree that getting an ideal case for the clinical examination was stressful. Nearly 50% of the respondents were unable to face their parents after failure. Patients not showing cooperation in following their home care instructions were a cause of stress which was agreed by 67% of the respondents. A total of 62% strongly agree, that the students have a fully loaded day which was a cause of stress. Responsibility of comprehensive patient care was stressful for 66.7% of the respondents who agree. Many of the respondents feel stressed about acquiring infectious diseases from the patients.

The analysis of the responses from the sample of students in the clinical years shows that the factors that are a cause of stress for them are examinations, rules and regulations laid down by the faculty, fear of being unable to catch up if getting behind with work, language barrier with teaching staff and a fully loaded day.

Discussion

The most prominent factor causing stress among students is “examinations”. Stress during the clinical years due to the examination is more because of the practical treatment of patients. The students are stressed as they may not be able to catch up with work. Students should complete their clinical requirements within the allotted time and should be enlightened about the positive effects of completing it on time. This will also take care of the stress caused by examinations [6].

A study by Gorter R et al., discussed that the patients not able to keep up appointments, is a cause of stress to the dental students [6]. Lack of time to relax also is a cause for stress. Added to this language barrier with the patient, understanding lectures, timing of the clinical patients and patient’s attitude towards the student and the treatment. These make the day for the students a fully loaded one. The results of the present study are in line with the studies by Fonseca J et al., where increased workload, time constraints and some aspects of clinical training are top stressors [7]. Also, the results of the studies conducted by Rosli TI et al., and Harris RC et al., have the same conclusions where the course requirements completion by the students created stress [8,9]. Social interactions and hobbies may be commonly used coping methods by the students to reduce stress. Workload of a student in the clinical years has consistently been more as the students have to do a comprehensive treatment for the patient by applying their knowledge and the cognitive skills.

The study by Hj Ramli NH is in line with this study where the faculty work and examinations are the main cause of students’ academic stress [10]. And students were using self-regulation as a coping mechanism to overcome the stress. Rules and regulations can be set placing the focus of the student for learning while certain rules and regulation including enforcing discipline are absolutely essential for maintenance and progress of students. A constant review is necessary to evaluate the stress caused to the students through the regulations. However, no compromise has to be made on overall interest and progress of students and the Institution.

The language of communication between the staff and the student is same as the medium of instruction in the institution. The students need to be made aware that strengthening their language skills right from the beginning will help them to break the barrier of language with the teaching staff. Al-Sowygh ZH, in his study also have found that language is a barrier and could have been a cause of stress [11]. The reason may be attributed to the fact that English is the second language, thus it is suggested to strengthen their English language. Understanding literature will also be easy for the students which will help them subsequently to reduce stress during examinations.

Faculty have a tendency to impart lot of knowledge in the shortest possible time. In their endeavour to ensure this, assignments and works are given to the students which becomes strenous. A similar finding was found in the study by Al-Samadani KH and Al-Dharrab A, where the students of mainly the fifth year were unable to complete the assignments given to them by the faculty [3]. A study by Kossioni AE et al., the students gave negative statements on teachers for not giving a good feedback and this may be attributed to the traditional system of assessment, where feedback to the students is not given at all on steps of their working [12]. Although the assessment system used by the Institute of the current study does not involve giving a feedback to the students during all the steps. However, there needs to be a proper orientation of the students to make them aware of the assessment methods by the staff.

The dental educational system in Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia, is for seven years including the one year of internship. Wherein the first year is an initial preparatory year. The first two years include the basic sciences in medicine and dentistry. The third year students are exposed to the clinical environment and the fourth and fifth and sixth years are mainly clinically oriented, which is followed by a 1 year of rotatory internship for exposure and practice [11]. The fourth and the sixth year students have a greater fear of failing in exams, as found in this study. The study by Al-Samadani KH and Al-Dharrab A, and Kumar S et al., also are in line with current study with a special focus on the fourth year students having stress of failing in their exams [3,13]. Fourth year students are getting exposed to the clinics and treating patients and this could be a primary factor related to stress. The sixth year students have more stress as they have to complete all the courses to move into the Internship.

A noteworthy finding by Harris RC et al., was that the students, in spite of high levels of stress, do not use the counselling services in the Institute readily available for them for help [9]. This could also be an explanation given to the respondents in the current study. The authors suggest coping mechanisms for reducing stress among students by having a clarity of goal, increase in self-confidence, interest towards the dentistry, improvement in knowledge and skills and improving the coordination between available time and task completion.

Limitation(s)

The study did not explore the various coping mechanisms that the dental students may have utilised when under stress.

Conclusion(s)

The dental students of Ibn Sina National College for Medical Studies Jeddah, have stress due to the clinical work during their graduation days. The factors that cause stress among the students in the present study are examinations, the rules and regulations of the faculty, fear of being unable to catch up with work, language barrier with teaching staff and a fully loaded day. It is recommended that further studies may be conducted in exploring the various coping mechanisms that the students may utilise to reduce stress.

*Variables are statistically significant with p<0.05

References

[1]Wali O, Kavitha OM, Vanka SA, Stress among preclinical students in a private dental school in Jeddah, Saudi Arabia Int J of Adv Res 2015 3(5):119-26.  [Google Scholar]

[2]Polychronopoulou A, Divaris K, Perceived is of stress among Greek dental students J Dent Edu 2005 69(6):687-92.  [Google Scholar]

[3]Al-Samadani KH, Al-Dharrab A, The Perception of Stress among Clinical Dental Students. Patil S, editor World Journal of Dentistry [Internet] 2013 4Jaypee Brothers Medical Publishing:24-28.10.5005/jp-journals-10015-1197  [Google Scholar]  [CrossRef]

[4]Agolla JE, Ongori H, An assessment of academic stress among undergraduate students: The case of University of Botswana Educ Res Rev 2009 4(2):63-70.  [Google Scholar]

[5]Houston E, What is goal setting and how to do it well Available at: https://positivepsychology.com/goal-setting/  [Google Scholar]

[6]Gorter R, Freeman R, Hammen S, Murtomaa H, Blinkhorn A, Humphris G, Psychological stress and health in under-graduate dental students: Fifth-year outcomes compared with first-year baseline results from five European dental schools Eur J Dent Educ 2008 12(2):61-68.10.1111/j.1600-0579.2008.00468.x18412732  [Google Scholar]  [CrossRef]  [PubMed]

[7]Fonseca J, Divaris K, Villalba S, Pizarro S, Fernandez M, Codjambassis A, Perceived is of stress amongst Chilean and Argentinean dental students Eur J Dent Educ 2013 17(1):30-38.10.1111/eje.1200423279390  [Google Scholar]  [CrossRef]  [PubMed]

[8]Rosli TI, Abdul Rahman R, Abdul Rahman SR, Ramli R, A survey of perceived stress among undergraduate dental students in universiti Kebangsaan Malaysia Singapore Dent J 2005 27(1):17-22.  [Google Scholar]

[9]Harris RC, Millichamp CJ, Thomson WM, Stress and coping in fourth-year medical and dental students N Z Dent J 2015 111(3):102-08.  [Google Scholar]

[10]Hj Ramli NH, Alavi M, Mehrinezhad SA, Ahmadi A, Academic stress and self-regulation among University students in Malaysia: mediator role of mindfulness Behav Sci (Basel) 201815 8(1):1210.3390/bs801001229342910  [Google Scholar]  [CrossRef]  [PubMed]

[11]Al-Sowygh ZH, Academic distress, perceived stress and coping strategies among dental students in Saudi Arabia Saudi Dent J 2013 25(3):97-105.10.1016/j.sdentj.2013.05.00224179318  [Google Scholar]  [CrossRef]  [PubMed]

[12]Kossioni AE, Varela R, Ekonomu I, Lyrakos G, Dimoliatis IDK, Students’ perceptions of the educational environment in a Greek Dental School, as measured by DREEM Eur J Dent Educ 2012 16(1):e73-78.10.1111/j.1600-0579.2011.00678.x22251357  [Google Scholar]  [CrossRef]  [PubMed]

[13]Kumar S, Dagli RJ, Mathur A, Jain M, Prabu D, Kulkarni S, Perceived is of stress amongst Indian dental students Europ J Dent Educ 2009 13(1):39-45.10.1111/j.1600-0579.2008.00535.x19196292  [Google Scholar]  [CrossRef]  [PubMed]