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 year | | Male | Female | Total |
---|
4th year | Number | 35 | 80 | 115 |
Percentage | 30.4% | 69.6% | 100.0% |
5th year | Number | 39 | 45 | 84 |
Percentage | 46.4% | 53.6% | 100.0% |
6th year | Number | 17 | 57 | 74 |
Percentage | 23.0% | 77.0% | 100.0% |
Total | Number | 91 | 182 | 273 |
Percentage | 33.3% | 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 more | 0.237 |
4th year BDS | 54 (47.0%) | 32 (27.8%) | 16 (13.9%) | 11 (9.6%) | 2 (1.7%) | |
5th year BDS | 48 (57.1%) | 17 (20.2%) | 13 (15.5%) | 5 (6.0%) | 1 (1.2%) | |
6th year BDS | 40 (54.1%) | 15 (20.3%) | 5 (6.8%) | 8 (10.8%) | 6 (8.1%) | |
Total | 142 (52.0%) | 64 (23.4%) | 34 (12.5%) | 24 (8.8%) | 9 (3.3%) | |
2. | I feel the competition with peers for getting good grades | 0.096 |
4th year BDS | 22 (19.1%) | 36 (31.3%) | 35 (30.4%) | 16 (13.9%) | 6 (5.2%) | |
5th year BDS | 27 (32.1%) | 23 (27.4%) | 18 (21.4%) | 9 (10.7%) | 7 (8.3%) | |
6th year BDS | 12 (16.2%) | 28 (37.8%) | 17 (23.0%) | 13 (17.6%) | 4 (5.4%) | |
Total | 61 (22.3%) | 87 (31.9%) | 70 (25.6%) | 38 (13.9%) | 17 (6.2%) | |
3. | I feel stressed during examinations* | 0.019 |
4th year BDS | 71 (61.7%) | 24 (20.9%) | 10 (8.7%) | 8 (7.0%) | 2 (1.7%) | |
5th year BDS | 66 (78.6%) | 6 (7.1%) | 7 (8.3%) | 3 (3.6%) | 2 (2.4%) | |
6th year BDS | 38 (51.4%) | 19 (25.7%) | 8 (10.8%) | 4 (5.4%) | 5 (6.8%) | |
Total | 175 (64.1%) | 49 (17.9%) | 25 (9.2%) | 15 (5.5%) | 9 (3.3%) | |
4. | I have difficulty in understanding lectures | 0.663 |
4th year BDS | 10 (8.7%) | 29 (25.2%) | 55 (47.8%) | 19 (16.5%) | 2 (1.7%) | |
5th year BDS | 10 (11.9%) | 21 (25.0%) | 36 (42.9%) | 13 (15.5%) | 4 (4.8%) | |
6th year BDS | 5 (6.8%) | 20 (27.0%) | 28 (37.8%) | 18 (24.3%) | 3 (4.1%) | |
Total | 25 (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 student | 0.652 |
4th year BDS | 17 (14.8%) | 12 (10.4%) | 20 (17.4%) | 31 (27.0%) | 35 (30.4%) | |
5th year BDS | 9 (10.7%) | 12 (14.3%) | 21 (25.0%) | 18 (21.4%) | 24 (28.6%) | |
6th year BDS | 8 (10.8%) | 6 (8.1%) | 12 (16.2%) | 22 (29.7%) | 26 (35.1%) | |
Total | 34 (12.5%) | 30 (11.0%) | 53 (19.4%) | 71 (26.0%) | 85 (31.1%) | |
6. | Having lack of confidence to be a successful dentist | 0.419 |
4th year BDS | 16 (13.9%) | 11 (9.6%) | 20 (17.4%) | 39 (33.9%) | 29 (25.2%) | |
5th year BDS | 7 (8.3%) | 7 (8.3%) | 15 (17.9%) | 21 (25.0%) | 34 (40.5%) | |
6th year BDS | 5 (6.8%) | 7 (9.5%) | 13 (17.6%) | 21 (28.4%) | 28 (37.8%) | |
Total | 28(10.3%) | 25 (9.2%) | 48 (17.6%) | 81 (29.7%) | 91 (33.3%) | |
7. | Having lack of time for relaxation | 0.170 |
4th year BDS | 50 (43.5%) | 27 (23.5%) | 26 (22.6%) | 7 (6.1%) | 5 (4.3%) | |
5th year BDS | 50 (59.5%) | 17 (20.2%) | 7 (8.3%) | 5 (6.0%) | 5 (6.0%) | |
6th year BDS | 33 (44.6%) | 17 (23.0%) | 11 (14.9%) | 8 (10.8%) | 5 (6.8%) | |
Total | 133 (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 year | 0.079 |
4th year BDS | 31 (27.2%) | 17 (14.9%) | 40 (35.1%) | 14 (12.3%) | 12 (10.5%) | |
5th year BDS | 27 (32.1%) | 21 (25.0%) | 22 (26.2%) | 8 (9.5%) | 6 (7.1%) | |
6th year BDS | 14 (18.9%) | 9 (12.2%) | 27 (36.5%) | 10 (13.5%) | 14 (18.9%) | |
Total | 72 (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 BDS | 32 (27.8%) | 35 (30.4%) | 35 (30.4%) | 9 (7.8%) | 4 (3.5%) | |
5th year BDS | 50 (59.5%) | 16 (19.0%) | 13 (15.5%) | 4 (4.8%) | 1 (1.2%) | |
6th year BDS | 28 (37.8%) | 21 (28.4%) | 17 (23.0%) | 5 (6.8%) | 3 (4.1%) | |
Total | 110 (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 program | 0.272 |
4th year BDS | 28 (24.3%) | 25 (21.7%) | 35 (30.4%) | 17 (14.8%) | 10 (8.7%) | |
5th year BDS | 20 (23.8%) | 19 (22.6%) | 23 (27.4%) | 15 (17.9%) | 7 (8.3%) | |
6th year BDS | 19 (25.7%) | 17 (23.0%) | 18 (24.3%) | 13 (17.6%) | 7 (9.5%) | |
Total | 67 (24.5%) | 61 (22.3%) | 76 (27.8%) | 45 (16.5%) | 24 (8.8%) | |
11. | Un approachability of the teaching staff | 0.997 |
4th year BDS | 31 (27.0%) | 28 (24.3%) | 31 (27.0%) | 18 (15.7%) | 7 (6.1%) | |
5th year BDS | 26 (31.0%) | 17 (20.2%) | 28 (33.3%) | 9 (10.7%) | 4 (4.8%) | |
6th year BDS | 29 (39.2%) | 16 (21.6%) | 14 (18.9%) | 8 (10.8%) | 7 (9.5%) | |
Total | 86 (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 BDS | 35 (30.4%) | 34 (29.6%) | 24 (20.9%) | 13 (11.3%) | 9 (7.8%) | |
5th year BDS | 42 (50.0%) | 11 (13.1%) | 22 (26.2%) | 6 (7.1%) | 3 (3.6%) | |
6th year BDS | 17 (23.0%) | 17 (23.0%) | 18 (24.3%) | 15 (20.3%) | 7 (9.5%) | |
Total | 94 (34.4%) | 62 (22.7%) | 64 (23.4%) | 34 (12.5%) | 19 (7.0%) | |
13. | I have fear of unemployment after graduation | 0.215 |
4th year BDS | 40 (34.8%) | 23 (20.0%) | 23 (20.0%) | 19 (16.5%) | 10 (8.7%) | |
5th year BDS | 26 (31.0%) | 19 (22.6%) | 20 (23.8%) | 9 (10.7%) | 10 (11.9%) | |
6th year BDS | 21 (28.4%) | 16 (21.6%) | 17 (23.0%) | 11 (14.9%) | 9 (12.2%) | |
Total | 87 (31.9%) | 58 (21.2%) | 60 (22.0%) | 39 (14.3%) | 29 (10.6%) | |
14. | I have difficulty in managing my financial resources | 0.934 |
4th year BDS | 31 (27.0%) | 22 (19.1%) | 29 (25.2%) | 20 (17.4%) | 13 (11.3%) | |
5th year BDS | 25 (29.8%) | 15 (17.9%) | 23 (27.4%) | 15 (17.9%) | 6 (7.1%) | |
6th year BDS | 14 (18.9%) | 17 (23.0%) | 17 (23.0%) | 14 (18.9%) | 12 (16.2%) | |
Total | 70 (25.6%) | 54 (19.8%) | 69 (25.3%) | 49 (17.9%) | 31 (11.4%) | |
15. | My marriage or engagement is postponed because of studies | 0.679 |
4th year BDS | 30 (26.1%) | 17 (14.8%) | 20 (17.4%) | 16 (13.9%) | 32 (27.8%) | |
5th year BDS | 30(35.7%) | 16(19.0%) | 11(13.1%) | 12(14.3%) | 15(17.9%) | |
6th year BDS | 16 (21.6%) | 13 (17.6%) | 14 (18.9%) | 13 (17.6%) | 18 (24.3%) | |
Total | 76 (27.8%) | 46 (16.8%) | 45 (16.5%) | 41 (15.0%) | 65 (23.8%) | |
16. | Necessity to postpone having children | 0.540 |
4th year BDS | 35 (30.4%) | 27 (23.5%) | 26 (22.6%) | 9 (7.8%) | 18 (15.7%) | |
5th year BDS | 34 (40.5%) | 20 (23.8%) | 12 (14.3%) | 9 (10.7%) | 9 (10.7%) | |
6th year BDS | 28 (37.8%) | 15 (20.3%) | 13 (17.6%) | 7 (9.5%) | 11 (14.9%) | |
Total | 97 (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 difficult | 0.754 |
4th year BDS | 31 (27.0%) | 22 (19.1%) | 34 (29.6%) | 14 (12.2%) | 14 (12.2%) | |
5th year BDS | 42 (50.0%) | 15 (17.9%) | 12 (14.3%) | 5 (6.0%) | 10 (11.9%) | |
6th year BDS | 28 (37.8%) | 15 (20.3%) | 16 (21.6%) | 6 (8.1%) | 9 (12.2%) | |
Total | 101 (37.0%) | 52 (19.0%) | 62 (22.7%) | 25 (9.2%) | 33 (12.1%) | |
18. | My personal physical health is affected | 0.074 |
4th year BDS | 37 (32.2%) | 30 (26.1%) | 34 (29.6%) | 6 (5.2%) | 8 (7.0%) | |
5th year BDS | 45 (53.6%) | 15 (17.9%) | 15 (17.9%) | 5 (6.0%) | 4 (4.8%) | |
6th year BDS | 26 (35.1%) | 19 (25.7%) | 19 (25.7%) | 3 (4.1%) | 7 (9.5%) | |
Total | 108 (39.6%) | 64 (23.4%) | 68 (24.9%) | 14 (5.1%) | 19 (7.0%) | |
19. | Distance and time needed to travel dental college | 0.153 |
4th year BDS | 43 (37.4%) | 34 (29.6%) | 21 (18.3%) | 8 (7.0%) | 9 (7.8%) | |
5th year BDS | 39 (46.4%) | 9 (10.7%) | 26 (31.0%) | 5 (6.0%) | 5 (6.0%) | |
6th year BDS | 30 (40.5%) | 17 (23.0%) | 14 (18.9%) | 6 (8.1%) | 7 (9.5%) | |
Total | 112 (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 BDS | 20 (17.4%) | 23 (20.0%) | 41 (35.7%) | 15 (13.0%) | 16 (13.9%) | |
5th year BDS | 20 (23.8%) | 18 (21.4%) | 19 (22.6%) | 18 (21.4%) | 9 (10.7%) | |
6th year BDS | 13 (17.6%) | 14 (18.9%) | 18 (24.3%) | 8 (10.8%) | 21 (28.4%) | |
Total | 53 (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 literature | 0.510 |
4th year BDS | 18 (15.7%) | 23 (20.0%) | 46 (40.0%) | 16 (13.9%) | 12 (10.4%) | |
5th year BDS | 12 (14.3%) | 20 (23.8%) | 35 (41.7%) | 15 (17.9%) | 2 (2.4%) | |
6th year BDS | 10 (13.5%) | 12 (16.2%) | 28 (37.8%) | 11 (14.9%) | 13 (17.6%) | |
Total | 40 (14.7%) | 55 (20.1%) | 109 (39.9%) | 42 (15.4%) | 27 (9.9%) | |
22. | Working on patients with dirty mouths | 0.087 |
4th year BDS | 29 (25.2%) | 23 (20.0%) | 32 (27.8%) | 15 (13.0%) | 16 (13.9%) | |
5th year BDS | 32(38.1%) | 14 (16.7%) | 20 (23.8%) | 11 (13.1%) | 7 (8.3%) | |
6th year BDS | 16 (21.6%) | 16 (21.6%) | 12 (16.2%) | 15 (20.3%) | 15 (20.3%) | |
Total | 77 (28.2%) | 53 (19.4%) | 64 (23.4%) | 41 (15.0%) | 38 (13.9%) | |
23. | I have lack of confidence in clinical decision making | 0.192 |
4th year BDS | 19 (16.5%) | 14 (12.2%) | 44 (38.3%) | 26 (22.6%) | 12 (10.4%) | |
5th year BDS | 12 (14.3%) | 13 (15.5%) | 31 (36.9%) | 17 (20.2%) | 10 (11.9%) | |
6th year BDS | 8 (10.8%) | 8 (10.8%) | 22 (29.7%) | 21 (28.4%) | 15 (20.3%) | |
Total | 39 (14.3%) | 35 (12.8%) | 97 (35.5%) | 64 (23.4%) | 37 (13.6%) | |
24. | I have difficulty in completing of clinical requirements | 0.098 |
4th year BDS | 20 (17.4%) | 20 (17.4%) | 42 (36.5%) | 20 (17.4%) | 13 (11.3%) | |
5th year BDS | 23 (27.4%) | 17 (20.2%) | 22 (26.2%) | 16 (19.0%) | 6 (7.1%) | |
6th year BDS | 15 (20.3%) | 11 (14.9%) | 22 (29.7%) | 13 (17.6%) | 13 (17.6%) | |
Total | 58 (21.2%) | 48 (17.6%) | 86 (31.5%) | 49 (17.9%) | 32 (11.7%) | |
25. | I am receiving criticism from staff in clinical work | 0.474 |
4th year BDS | 14 (12.2%) | 17 (14.8%) | 41 (35.7%) | 27 (23.5%) | 16 (13.9%) | |
5th year BDS | 18 (21.4%) | 11 (13.1%) | 32 (38.1%) | 19 (22.6%) | 4 (4.8%) | |
6th year BDS | 10 (13.5%) | 10 (13.5%) | 24 (32.4%) | 16 (21.6%) | 14 (18.9%) | |
Total | 42 (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 appointments | 0.388 |
4th year BDS | 71 (61.7%) | 15 (13.0%) | 15 (13.0%) | 7 (6.1%) | 7 (6.1%) | |
5th year BDS | 65 (77.4%) | 6 (7.1%) | 10 (11.9%) | 2 (2.4%) | 1 (1.2%) | |
6th year BDS | 44 (59.5%) | 10 (13.5%) | 11 (14.9%) | 5 (6.8%) | 4 (5.4%) | |
Total | 180 (65.9%) | 31 (11.4%) | 36 (13.2%) | 14 (5.1%) | 12 (4.4%) | |
27. | I have difficulty in learning clinical procedures | 0.255 |
4th year BDS | 21 (18.3%) | 20 (17.4%) | 33 (28.7%) | 30 (26.1%) | 11 (9.6%) | |
5th year BDS | 17 (20.2%) | 15 (17.9%) | 27 (32.1%) | 18 (21.4%) | 7 (8.3%) | |
6th year BDS | 12 (16.2%) | 14 (18.9%) | 10 (13.5%) | 22 (29.7%) | 16 (21.6%) | |
Total | 50 (18.3%) | 49 (17.9%) | 70 (25.6%) | 70 (25.6%) | 34 (12.5%) | |
28. | I hate the atmosphere created by clinical supervisors | 0.316 |
4th year BDS | 36 (31.3%) | 24 (20.9%) | 41 (35.7%) | 11 (9.6%) | 3 (2.6%) | |
5th year BDS | 37 (44.0%) | 19 (22.6%) | 14 (16.7%) | 9 (10.7%) | 5 (6.0%) | |
6th year BDS | 27 (36.5%) | 15 (20.3%) | 20 (27.0%) | 6 (8.1%) | 6 (8.1%) | |
Total | 100 (36.6%) | 58 (21.2%) | 75 (27.5%) | 26 (9.5%) | 14 (5.1%) | |
29. | There is lack availability of supervisors in clinic | 0.071 |
4th year BDS | 59 (51.3%) | 21 (18.3%) | 18 (15.7%) | 10 (8.7%) | 7 (6.1%) | |
5th year BDS | 35 (41.7%) | 23 (27.4%) | 17 (20.2%) | 5 (6.0%) | 4 (4.8%) | |
6th year BDS | 30 (40.5%) | 20 (27.0%) | 14 (18.9%) | 6 (8.1%) | 4 (5.4%) | |
Total | 124 (45.4%) | 64 (23.4%) | 49 (17.9%) | 21 (7.7%) | 15 (5.5%) | |
30. | I have shortage of allocated clinical time | 0.163 |
4th year BDS | 56 (48.7%) | 23 (20.0%) | 23 (20.0%) | 2 (1.7%) | 11 (9.6%) | |
5th year BDS | 40 (48.2%) | 20 (24.1%) | 11 (13.3%) | 8 (9.6%) | 4 (4.8%) | |
6th year BDS | 29 (39.2%) | 22 (29.7%) | 13 (17.6%) | 7 (9.5%) | 3 (4.1%) | |
Total | 125 (46.0%) | 65 (23.9%) | 47 (17.3%) | 17 (6.2%) | 18 (6.6%) | |
31. | I have language barrier with patients | 0.749 |
4th year BDS | 16 (13.9%) | 15 (13.0%) | 33 (28.7%) | 22 (19.1%) | 29 (25.2%) | |
5th year BDS | 16 (19.0%) | 9 ()10.7% | 25 (29.8%) | 24 (28.6%) | 10 (11.9%) | |
6th year BDS | 10 (13.5%) | 12 (16.2%) | 17 (23.0%) | 16 (21.6%) | 19 (25.7%) | |
Total | 42 (15.4%) | 36 (13.2%) | 75 (27.5%) | 62 (22.7%) | 58 (21.2%) | |
32. | Availability of lab technicians is in shortage | 0.105 |
4th year BDS | 57 (49.6%) | 16 (13.9%) | 15 (13.0%) | 17 (14.8%) | 10 (8.7%) | |
5th year BDS | 46 (54.8%) | 16 (19.0%) | 9 (10.7%) | 9 (10.7%) | 4 (4.8%) | |
6th year BDS | 45 (60.8%) | 11 (14.9%) | 10 (13.5%) | 4 (5.4%) | 4 (5.4%) | |
Total | 148 (54.2%) | 43 (15.8%) | 34 (12.5%) | 30 (11.0%) | 18 (6.6%) | |
33. | Differences in opinion between clinical staff concerning patient treatment | 0.288 |
4th year BDS | 49 (42.6%) | 22 (19.1%) | 26 (22.6%) | 8 (7.0%) | 10 (8.7%) | |
5th year BDS | 32 (38.1%) | 20 (23.8%) | 22 (26.2%) | 5 (6.0%) | 5 (6.0%) | |
6th year BDS | 32 (43.2%) | 16 (21.6%) | 17 (23.0%) | 6 (8.1%) | 3 (4.1%) | |
Total | 113 (41.4%) | 58 (21.2%) | 65 (23.8%) | 19 (7.0%) | 18 (6.6%) | |
34. | Getting an ideal case for clinical examination is difficult | 0.516 |
4th year BDS | 42 (36.5%) | 21 (18.3%) | 37 (32.2%) | 8 (7.0%) | 7 (6.1%) | |
5th year BDS | 39 (46.4%) | 17 (20.2%) | 21 (25.0%) | 3 (3.6%) | 4 (4.8%) | |
6th year BDS | 32 (43.2%) | 19 (25.7%) | 10 (13.5%) | 6 (8.1%) | 7 (9.5%) | |
Total | 113 (41.4%) | 57 (20.9%) | 68 (24.9%) | 17 (6.2%) | 18 (6.6%) | |
35. | I have a fear of facing parents after failure | 0.939 |
4th year BDS | 27 (23.5%) | 16 (13.9%) | 35 (30.4%) | 22 (19.1%) | 15 (13.0%) | |
5th year BDS | 23 (27.4%) | 10 (11.9%) | 24 (28.6%) | 19 (22.6%) | 8 (9.5%) | |
6th year BDS | 11 (14.9%) | 9 (12.2%) | 20 (27.0%) | 20 (27.0%) | 14 (18.9%) | |
Total | 61 (22.3%) | 35 (12.8%) | 79 (28.9%) | 61 (22.3%) | 37 (13.6%) | |
36. | Lack of cooperation by patients in their home care | 0.170 |
4th year BDS | 41 (35.7%) | 29 (25.2%) | 32 (27.8%) | 9 (7.8%) | 4 (3.5%) | |
5th year BDS | 31 (36.9%) | 24 (28.6%) | 20 (23.8%) | 5 (6.0%) | 4 (4.8%) | |
6th year BDS | 26 (35.1%) | 23 (31.1%) | 11 (14.9%) | 9 (12.2%) | 5 (6.8%) | |
Total | 98 (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 BDS | 66 (57.4%) | 26 (22.6%) | 13 (11.3%) | 4 (3.5%) | 6 (5.2%) | |
5th year BDS | 62 (73.8%) | 8 (9.5%) | 11 (13.1%) | 3 (3.6%) | 0 (0.0%) | |
6th year BDS | 41 (55.4%) | 17 (23.0%) | 5 (6.8%) | 3 (4.1%) | 8(10.8%) | |
Total | 169 (61.9%) | 51 (18.7%) | 29 (10.6%) | 10 (3.7%) | 14 (5.1%) | |
38. | I have more responsibilities for comprehensive patient care | 0.525 |
4th year BDS | 44 (38.3%) | 29 (25.2%) | 24 (20.9%) | 10 (8.7%) | 8 (7.0%) | |
5th year BDS | 34 (40.5%) | 19 (22.6%) | 25 (29.8%) | 5 (6.0%) | 1 (1.2%) | |
6th year BDS | 32 (43.2%) | 24 (32.4%) | 8 (10.8%) | 6 (8.1%) | 4 (5.4%) | |
Total | 110 (40.3%) | 72 (26.4%) | 57 (20.9%) | 21 (7.7%) | 13 (4.8%) | |
39. | I fear of getting infectious diseases | 0.556 |
4th year BDS | 70 (60.9%) | 22 (19.1%) | 12 (10.4%) | 6 (5.2%) | 5 (4.3%) | |
5th year BDS | 60 (71.4%) | 9 (10.7%) | 7 (8.3%) | 8 (9.5%) | 0 (0.0%) | |
6th year BDS | 40 (54.1%) | 16 (21.6%) | 10 (13.5%) | 3 (4.1%) | 5 (6.8%) | |
Total | 170 (62.3%) | 47 (17.2%) | 29 (10.6%) | 17 (6.2%) | 10 (3.7%) | |
40. | Inconsistency of feedback regarding my work | 0.128 |
4th year BDS | 55 (47.8%) | 20 (17.4%) | 22 (19.1%) | 12 (10.4%) | 6 (5.2%) | |
5th year BDS | 52 (61.9%) | 13 (15.5%) | 10 (11.9%) | 6 (7.1%) | 3 (3.6%) | |
6th year BDS | 30 (40.5%) | 18 (24.3%) | 13 (17.6%) | 8 (10.8%) | 5 (6.8%) | |
Total | 137 (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