Introduction
With the recent changes in scoring of the National Board Dental Examinations and grading systems in some dental schools, ranking prospective orthodontic applicants has become a challenge.
Methods
A 31-item survey was sent to orthodontic program directors in the United States to determine admission practices of all accredited specialty orthodontic programs.
Results
Forty-four of 64 program directors responded (69%). This study showed a wide variation of admission practices among these programs. The only consistent part of admissions in all programs was the interview process. The top factors considered for each applicant were interview ratings, dental school class rank, and letters of recommendation. The top sources of recommendations were the orthodontic department chair, the graduate program director, and the predoctoral orthodontic program director. The top 3 character traits considered most favorable were maturity, and good verbal and listening skills.
Conclusions
Accredited orthodontic programs in the United States follow different procedures in assessing applicants for admission. It is important to consider both academic and nonacademic measures in assessing applicant information in a standardized manner to ensure a fair and efficient selection process.
At the 2010 American Dental Education Association (ADEA) Annual Session, the Section on Orthodontics and the Section on Graduate and Postgraduate Education cosponsored a well-attended symposium on the future of postgraduate program admissions. The main issue was how to assess prospective applicants of advanced education programs in the light of the pass-fail grading systems in some dental schools and pass-fail scoring for National Board Dental Examinations. This is a tremendous concern, not only to the specialty program directors and the faculties, but also to the prospective applicants.
Acceptance in an orthodontic program is highly competitive. The latest American Dental Association survey of advanced dental education (2009) estimated that the number of applications to US orthodontic programs was 10,373 for the academic year 2007 to 2008. This enormous number reflects the fact that students often submit applications to various programs. The statistical data gathered from the National Matching Services Web site showed 481 match applicants in the 2007 application cycle, of which 251 students matched. The American Dental Association survey included nonmatch positions and reported that 353 applicants enrolled as first-year residents that year. Applicant selection is an arduous task, because objective application materials (board scores, grade point averages) and subjective materials (recommendation letters and interviews) must be considered.
The graduate program applicant selection process has been studied in depth by other fields of medicine and some specialties of dentistry, but there is limited published literature in orthodontics, particularly in the United States. Bhalla et al published a study on orthodontic program selection processes in Canada. They interviewed program directors, faculty, and students and concluded that programs do not have a consensus as to selection processes, but all sought candidates who are intellectually capable and possess a certain set of skills and positive attributes. Another publication from the United States reported factors that influence an applicant’s ranking of institutions for the National Matching Services, compared with the perceptions of program directors. Satisfied current residents was the top factor when ranking for applicants; this coincided with what the program directors perceived. The applicants’ actual ranking of factors was approximately similar to the program directors’ perceptions, although it was statistically different. However, none of these studies discussed the essential question: “How is the orthodontic applicant, particularly in US programs, selected?”
The primary objective of this study was to evaluate the factors that influence applicant selection in accredited graduate orthodontic programs in the United States from the perspectives of the program directors. The information gathered can also serve as a supplemental guide to prospective orthodontic program applicants regarding the graduate orthodontic application process, and provide a basis for all programs to streamline the candidate selection process.
Material and methods
In this study, we used a 31-item questionnaire developed with slight modifications from that of Yuan et al used for prosthodontic program directors. The survey instrument was approved by the institutional review board of the University of Illinois at Chicago (protocol number 2009-1056). It was sent by mail on January 4, 2010, with a due date of February 15, 2010, to the program directors of all 64 accredited graduate orthodontic programs in the United States. The list of directors’ names and addresses was obtained from the American Association of Orthodontists. The survey instrument was anonymous, and the packet contained a prestamped envelope for the response. A reminder letter was mailed 6 weeks after the initial mailing to increase the response rate.
The survey questions were divided into 6 sections. Section A pertained to general information about the program. Section B inquired about the application materials required for submission. These questions addressed the importance (not requested, little importance, some importance, or very important) of the different application requirements and the sources of the recommendation letters. Section C contained questions about the interview process. These were ranked by the program directors as positive, negative, or neutral. A mean score was assigned to each characteristic, and these were subsequently ranked from most positive to most negative. Section D addressed the decision-making process of selecting qualified applicants. Section E focused on a retrospective view of currently accepted applicants and selection criteria. Finally, section F asked for brief demographic information on the program directors.
Upon obtaining the completed surveys, we tabulated the answers on an electronic spreadsheet (Excel 2003; Microsoft, Redmond, Wash) and obtained descriptive statistics with the same software. The data were analyzed and compiled into means, medians, modes, standard deviations, and ranges. The results were tabulated and ranked appropriately when applicable.
Results
Of the 64 surveys, 44 responses were received, for a 69% response rate. Few questions were unanswered, and those responses were not included in the data analysis. Thus, not all responses for each question totaled 44 ( Appendix ).
The majority of accredited orthodontic programs in the United States (93%, n = 41) were university based. More than half of the responding programs (55%, n = 24) received 101 to 200 applications in the most recent application cycle for admission in the fall of 2010. The median and mean number of applicants accepted for the 2010 to 2011 academic year was 5, with a range of 1 to 15. Internationally trained dentists were accepted in more than half of the programs (56%, n = 24).
With regard to the percentages of applicants who met the basic requirements for consideration, there was no agreement among the program directors, and the responses were similarly distributed, from 1% to 20% to 81% to 100% of applicants who met basic requirements. The majority of the responding program directors (83%, n = 35) reported that 81% to 100% of their graduating students will remain in the United States for either private practice or academia. The sizes of the programs have remained steady for most institutions, according to their respective directors.
The majority of the program directors (77%, n = 34) reported using the Postdoctoral Application Support Service administered by the ADEA. Tables I and II give the responses to survey questions 12 and 13, respectively. A mean score was assigned to each response choice, and these scores were subsequently ranked according to perceived importance. According to the program directors, the top 3 factors in the application were interview ratings, dental school class rank, and letters of recommendation and dental school clinical grades (tie). The least important factors or those that were not commonly requested were on-site oral presentations, dexterity (wire-bending) skills, and orthodontic externships. For letters of recommendation, the most highly regarded source was the orthodontic department chair, followed by the orthodontic graduate program director, and the orthodontic predoctoral program director.
| Mean score | SD | n | Rank | |
|---|---|---|---|---|
| Interview ratings | 3.9 | 0.3 | 44 | 1 |
| Dental school class rank | 3.7 | 0.7 | 43 | 2 |
| Letters of recommendation | 3.5 | 0.5 | 44 | 3 |
| Dental school grades (clinical) | 3.5 | 0.5 | 44 | 3 |
| Personal statement | 3.4 | 0.6 | 44 | 4 |
| Resident feedback | 3.4 | 0.6 | 44 | 4 |
| National board scores (part I) | 3.4 | 0.8 | 43 | 5 |
| Academic honors | 3.3 | 0.7 | 44 | 6 |
| Dental school grades (basic science) | 3.2 | 1.0 | 41 | 7 |
| Publications/research experience | 3.1 | 0.6 | 44 | 8 |
| Extramural activity | 3.1 | 0.6 | 40 | 9 |
| Clinical honors | 3.1 | 0.7 | 44 | 10 |
| Advanced degree (PhD) | 3.0 | 0.8 | 44 | 11 |
| Dental school grades (orthodontics) | 3.0 | 0.9 | 43 | 12 |
| National board scores (part II) | 3.0 | 0.9 | 43 | 12 |
| Advanced degree (MS) | 2.9 | 0.8 | 44 | 13 |
| Dental school attended | 2.8 | 0.7 | 44 | 14 |
| GPR/AEGD | 2.8 | 0.8 | 43 | 15 |
| Military experience | 2.7 | 0.8 | 44 | 16 |
| Private practice experience | 2.7 | 0.8 | 43 | 17 |
| Graduate record examination scores | 2.7 | 1.1 | 44 | 18 |
| TOEFL scores | 2.7 | 1.1 | 43 | 19 |
| College grades (basic sciences) | 2.6 | 0.8 | 44 | 20 |
| College grades (overall) | 2.5 | 0.9 | 42 | 21 |
| Orthodontic-related knowledge | 2.4 | 0.8 | 44 | 22 |
| Presentations at orthodontic meetings | 2.4 | 0.8 | 44 | 22 |
| Orthodontics externship | 2.4 | 0.8 | 42 | 23 |
| Dexterity skills (eg, on-site wire bending) | 2.0 | 1.0 | 44 | 24 |
| On-site oral presentations | 1.9 | 1.1 | 43 | 25 |
| Mean score | SD | n | Rank | |
|---|---|---|---|---|
| Orthodontic department chair | 3.3 | 0.8 | 43 | 1 |
| Orthodontic graduate program director | 3.3 | 0.9 | 43 | 2 |
| Orthodontic predoctoral program director | 3.2 | 0.8 | 43 | 3 |
| Research advisor | 3.0 | 0.8 | 43 | 4 |
| Orthodontic faculty | 3.0 | 1.0 | 41 | 5 |
| Dean of dental school | 2.9 | 0.8 | 43 | 6 |
| Private practice orthodontist | 2.5 | 0.8 | 43 | 7 |
| General dentist | 2.4 | 0.7 | 43 | 8 |
| Other dental specialist | 2.4 | 0.8 | 43 | 9 |
| Program alumni | 2.4 | 1.0 | 42 | 10 |
| Current orthodontic resident | 2.0 | 0.8 | 43 | 11 |
| College advisor | 1.9 | 0.9 | 42 | 12 |
All 44 program directors reported requiring an interview as part of the resident selection process. The final decision on which applicants to invite for an interview was commonly the responsibility of a committee. The committee was composed of various people, including the program director, chair, faculty, and so on. The average number of applicants invited for an interview was 29 (range, 10-60). The duration of the interview process varied greatly, but almost half of the programs had interviews that lasted 4 to 8 hours. Also, the majority of the programs (89%, n = 39) included an informal event or an evening social in the interview process. As with deciding whom to invite, the interviews were also conducted by combinations of persons, including the program director, department chair, residents, faculty, staff, and so on. Table III lists the different applicant characteristics noted during the interview. Maturity, verbal skills, and listening skills were the top 3 positive characteristics, ranked in order of importance. The least favored characteristics were aggressiveness and nervousness.
| Mean score | SD | n | Rank | |
|---|---|---|---|---|
| Maturity | 2.9 | 0.6 | 42 | 1 |
| Verbal skills | 2.8 | 0.6 | 42 | 2 |
| Listening skills | 2.8 | 0.7 | 42 | 3 |
| Presentable appearance/attire | 2.8 | 0.8 | 41 | 4 |
| Ability to ask relevant questions | 2.7 | 0.7 | 42 | 5 |
| Analytical thinking | 2.7 | 0.7 | 42 | 5 |
| Cooperation skills | 2.7 | 0.8 | 41 | 6 |
| Social skills | 2.7 | 0.8 | 41 | 6 |
| Confidence | 2.7 | 0.8 | 41 | 6 |
| Honesty | 2.7 | 0.9 | 40 | 7 |
| Empathy | 2.6 | 0.8 | 41 | 8 |
| Organization skills | 2.6 | 0.8 | 41 | 8 |
| Enthusiasm | 2.6 | 0.9 | 40 | 9 |
| Research experience | 2.5 | 0.8 | 41 | 10 |
| Agreeability | 2.5 | 0.9 | 40 | 11 |
| Teaching potential | 2.4 | 0.7 | 42 | 12 |
| Aggressiveness | 1.6 | 0.9 | 40 | 13 |
| Anxiousness/nervousness | 1.5 | 0.8 | 40 | 14 |
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