Orthodontic education programs: An international comparison of students’ views and experiences

Introduction

The purpose of this study was to identify the demographic characteristics of students completing certificate programs in orthodontics, and the curriculum and financial characteristics of orthodontic programs in the English-speaking world.

Methods

An online survey was used to question orthodontic students studying in the 93 programs worldwide in countries where the first language is English. The questionnaire was built by using the online survey tool www.surveymonkey.com , and the students were predominantly contacted directly via e-mail.

Results

Of the 301 respondents (an estimated response rate of 33%), the majority were men, had an average age of 29.8 years, and were mostly from programs in the United States. The mean program durations were 31.0 months in the United States and 37.1 months in the Commonwealth, with mean total patient loads of 84 and 106, respectively. Various treatment modalities were used in both groups. The mean annual tuition fee was considerably higher in the United States. The overall mean debt at graduation was $118,200, and the mean expected income 5 years after graduation was $283,200. Private practice was the most popular career path (90.3%), with fewer than a third of the respondents stating that they would consider an academic career.

Conclusions

This study indicates that the demographic characteristics of orthodontic students are similar to those most recently reported, with the proportion of female students continuing to increase. The numbers of transitional dentition patients and total patient case loads are increasing, and students are being exposed to an increasingly wide range of treatment techniques. A continuing increase in tuition fees was reported, along with increased levels of debt at graduation, and fewer students intend to have an academic career.

Previous studies on the characteristics of students completing certificate programs in orthodontics (hereafter called “orthodontic students” or “students”) have identified increases in both the average age of the students and the proportion of female students over the last 20 years. The duration of orthodontic education programs has also increased over the same period, particularly in the United States, where graduate programs have been moving from a 2-year to a 3-year structure. The number of patients treated by a typical student has almost doubled over the same period, and the numbers of transitional dentition and craniofacial or syndromic patients have also markedly increased. An increasingly wide range of clinical experience is being gained by students, but this seems to be going hand in hand with less emphasis on research. Over the last 20 years, there have been many variations in the cost of tuition and the amount of financial support afforded to students in different programs.

The aim of this study was to describe the demographic characteristics of current orthodontic students and the features of their programs, with particular attention on any differences between programs in the United States and the Commonwealth. These data will be used to identify (1) patterns in the selection of students on an international level and (2) strengths and weaknesses in the content and provision of orthodontic education among different programs. Financial issues affecting orthodontic students will also be highlighted.

Material and methods

An online survey was used to obtain information from orthodontic students enrolled in 93 programs in countries where the predominant language is English, with the addition of Hong Kong and Singapore. The programs were divided, for analytical purposes, into the 60 programs in the United States (65%) and the 33 programs in other countries (35%). For ease of description, the latter group was designated the Commonwealth, since all constituent countries (Australia, Canada, Hong Kong, New Zealand, Republic of Ireland, Singapore, South Africa, and United Kingdom) are, or have been, members of the Commonwealth of Nations. The initial contact with each program was made via email, with an exhaustive online search undertaken to obtain the contact details of (in descending order of preference) the individual students, the program director, other faculty members, the faculty secretary, and the dean of the program. The initial e-mail invited the students to visit the provided link to the online survey. Program directors or other faculty members, where applicable, were asked to either forward the e-mail to their students or reply with the addresses of their students so that they could be contacted directly.

The questionnaire was compiled by using the online survey tool www.surveymonkey.com and was accessible to the respondents between January and March 2007. Questions covered the students’ demographic characteristics and the general, clinical, and financial characteristics of their orthodontic programs. Reminder e-mails were sent to nonrespondents every week during the survey period. Upon closure of the survey, the response data were downloaded from the Web site in a spreadsheet format. All financial data were converted to US dollars by using the appropriate exchange rate on March 26, 2007.

The questionnaire responses were analyzed by using the Statistical Package for the Social Sciences (version 14, SPSS, Chicago, Ill). Associations between categorical variables were tested for significance with the chi-square test. Analysis of variance (ANOVA) was used for continuous dependent variables. The alpha value was set at 0.05.

Results

The demographic characteristics of the respondents are presented by program location in Table I . One respondent did not answer the age question. Most respondents (nearly 60%) were studying in the United States. Citizenship was also investigated; about half had US citizenship, and the rest represented 28 other countries. There was a predominance of men, both overall (54.8%) and in US programs (65.5%), although there was a slight predominance of women (51.5%) among the Commonwealth programs. Some 40% of respondents were younger than 29 years; the mean age overall was 29.8 years, and the median age was 29 years. Among US respondents, 45.4% were under 29 years of age, 23.6% were 29 to 30, and 31.0% were older than 31. Among Commonwealth respondents, these proportions were 32.3%, 32.3%, and 34.6%, respectively, with data missing for 1 respondent.

Table I
Respondents’ demographic characteristics
United States Commonwealth Total
All respondents (n) 174 (57.8%) 127 (42.2%) 301 (100.0%)
Sex (n)
Male 108 (65.5%) 57 (34.5%) 165 (54.8%)
Female 66 (48.5%) 70 (51.5%) 136 (45.2%)
Mean age (y) (SD) 29.7 (3.7) 29.9 (3.0) 29.8 (3.4)
Age group
<29 y 79 (65.8%) 41 (34.2%) 120 (40.0%)
29-30 y 41 (50.0%) 41 (50.0%) 82 (27.3%)
>31 y 54 (55.1%) 44 (44.9%) 98 (32.7%)

P <0.05

Data missing for 1 respondent.

The response rate was hard to assess, because there were no current data on the number of orthodontic students in the Commonwealth or the United States. Students whose e-mail addresses were listed on program Web sites were contacted directly; however, many responded to the survey after receiving forwarded invitation e-mails from their program directors or students in other programs. The number of individual e-mail addresses in the data base therefore does not indicate the total number of possible respondents.

The American Dental Association’s Advanced Dental Education Infopak 2005 stated that the 2003-2004 Survey of Advanced Dental Education listed 48 graduate programs at dental schools and a further 10 at facilities that were not affiliated with a dental school. It stated that there were 277 orthodontic students in 2002 and 2003. Isaacson reported that 230 students commenced study in an orthodontic program in the United States in 2000. If it is assumed that this estimate was similar to the current situation, it could be estimated (considering that the mean duration of an orthodontic program in the United States is 31 months, or 2.6 years) that there are 594 students in US orthodontic programs at any time. According to the American Dental Association’s Web site, there are currently 60 orthodontic programs in the United States; this gives an average of 9.9 students per program. Extrapolating this average to the 93 courses in other English-speaking countries, there are likely to be approximately 920 orthodontic students worldwide at any time. A total of 301 responses were received, giving an estimated 33% response rate.

Information on primary dental qualification class position was provided by 290 respondents ( Table II ). More than 80% of the respondents indicated they had been in the top academic quartile of their dental class. A greater proportion of women had been in this group, as had more respondents from the youngest age group, and more from US programs. Only 9 respondents stated that they had been in the bottom half of their dental class, and only 1 reported having been in the lowest quartile. A greater proportion of Commonwealth than US respondents had been below the top quartile.

Table II
Respondents’ predoctoral (dental) class positions (%)
Top quartile Below top quartile
All respondents 84.5 15.5
Program location
United States 90.6 9.4
Commonwealth 75.8 24.2
Sex
Male 80.6 19.4
Female 89.2 10.8
Age group
<29 y 92.3 7.7
29-30 y 84.6 15.4
>31 y 74.5 25.5

Data missing for 11 respondents

P <0.05

Data missing for 12 respondents.

Information on area of research was provided by 227 (75.4%) respondents ( Table III ). The most common area of research (reported by 1 in 3 in both the US and Commonwealth programs) was clinical; however, differences were seen in other fields. A greater proportion of US research involved materials or radiography, and a greater proportion in the Commonwealth was animal based.

Table III
Categories of research (%)
Category of research Program location Total
United States Commonwealth
Clinical 32.0 30.3 31.2
Biologic or animal study 11.7 23.2 16.7
Epidemiologic 13.3 16.2 14.5
Materials 20.3 10.1 15.9
Cephalometric or radiographic 18.8 11.1 15.4
Other 3.9 9.1 6.1

Data missing for 74 respondents

P <0.05

As can be expected, a wide array of research topics was reported, some which did not fall into the categories above.

Data on the numbers and types of patients treated by the respondents are presented in Table IV . Respondents from Commonwealth programs reported higher overall active patient loads (about 100 patients) than their US counterparts (about 85 patients); these data include both new starts and transfer cases. US students started more new patients and treated more surgical and more growth-modification patients. Numbers of the other patient types were similar between US and Commonwealth respondents. The average numbers of patients that a student was expected to present for his or her final examination were 9.7 in the United States and 10.3 in the Commonwealth.

Table IV
Average patient numbers (SD in parentheses)
Patient type Program location Missing responses
United States Commonwealth
Total active patients 84.3 (43.3) 106.1 (48.8) 23
New patient starts 57.0 (26.3) 92.5 (42.1) 23
Surgical 4.1 (3.0) 8.1 (7.9) 25
Syndrome 2.6 (3.5) 2.9 (4.9) 33
Transitional dentition 15.7 (15.6) 15.5 (13.4) 34
Temporary anchorage 3.5 (3.0) 3.3 (4.2) 39
Growth modification 9.8 (11.5) 17.2 (11.2) 28
Presentation cases 9.7 (12.0) 10.3 (16.2) 48

P <0.05

Includes cleft lip and palate patients.

Four of 5 respondents used a preadjusted edgewise system predominantly ( Table V ), with no significant difference by program location. Other systems (including Begg and tip-edge) dominated for less than 7% of respondents. Some 21 respondents did not reply to this section of the survey. Commonwealth courses were far more likely to use a 0.022-in system only, whereas US programs used both 0.018-in and 0.022-in slot sizes. About half of both US and Commonwealth respondents reported sometimes using self-ligating bracket systems; however, US respondents were more likely to frequently use these systems.

Table V
Technical aspects of bracket systems (%)
Program location
United States Commonwealth
Treatment systems used
Preadjusted edgewise 80.7 91.6
Standard edgewise 51.6 21.8
Begg 1.9 10.9
Tip-edge 16.1 63.0
Lingual 20.5 22.7
Invisalign 90.7 35.3
Other 14.3 17.6
Slot sizes used
0.018 in only 13.6 5.1
0.022 in only 24.1 70.3
Both 0.018 and 0.022 in 62.3 24.6
Self-ligating systems used
Never 3.7 19.5
Sometimes 54.9 49.6
Often/always 41.4 27.1

Percentages might not add up to 100% because multiple responses were allowed

Data missing for 21 respondents

P <0.05.

Data on program characteristics are presented by program location in Table VI . At just over 3 years, mean program duration was significantly longer in the Commonwealth than in the United States, although the Commonwealth programs had more holidays per year than did the US programs. There were also significant differences in average weekly time allotments, with more clinical time allocated in the US programs and more after-hours work undertaken in the Commonwealth programs.

Table VI
Mean total program duration, mean holidays per year, and mean weekly time breakdown (minimum and maximum values in parentheses)
Program location Overall Missing responses
United States Commonwealth
Total program duration (mo) 31.0 (24, 48) 37.1 (24, 60) 33.6 (24, 60) 14
Holidays per year (wk) 3.7 (1, 10) 5.6 (0, 14) 4.5 (0, 14) 18
Mean weekly time breakdown (h)
Clinical 24.8 (3, 30) 21.7 (5, 30) 23.5 (3, 30) 16
Didactic 10.6 (0, 30) 7.2 (0, 30) 9.2 (0, 30) 28
Research 4.7 (0, 20) 6.3 (0, 30) 5.3 (0, 30) 37
Self-directed study 5.2 (0, 29) 7.2 (0, 30) 6.1 (0, 30) 54
After-hours work 9.7 (1, 40) 16.0 (0, 42) 12.4 (0, 42) 18

P <0.05.

A summary of financial data is presented in Table VII . Course tuition was significantly less expensive in the Commonwealth than in the United States, with over 70% of respondents from the former group having fees below $20,000, but only 45% of the US respondents fell into this group. Approximately a third of US respondents had fees of more than $30,000 per year, whereas only a tenth of those from the Commonwealth fell into this group. The mean tuition fee in the Commonwealth was significantly lower than that in the United States.

Table VII
Summary of financial data ($1000s) by sex, program location, age group, and ethnicity (SD in parentheses)
Annual tuition Annual cost of living Annual scholarship or stipend Annual government benefits Debt at graduation Expected annual income at 5 years
Overall 20.4 (17.9) 27.3 (15.6) 16.2 (16.7) 16.1 (21.0) 118.2 (114.5) 283.2 (162.2)
Sex
Male 21.2 (19.2) 26.8 (15.6) 14.8 (16.2) 16.2 (21.4) 127.1 (114.5) 307.1 (179.5)
Female 19.4 (16.0) 27.8 (15.6) 18.5 (17.4) 15.8 (20.6) 105.7 (113.9) 259.6 (189.9)
Program location
United States 23.2 (19.4) 26.1 (13.9) 13.0 (12.1) 15.1 (15.1) 167.5 (116.4) 320.3 (167.8)
Commonwealth 16.5 (14.8) 29.0 (17.7) 22.7 (22.2) 17.5 (28.0) 40.2 (50.2) 223.9 (133.5)
Age group
<29 y 21.5 (18.1) 23.3 (12.4) 10.9 (11.4) 12.1 (6.4) 119.5 (110.5) 284.5 (176.5)
29-30 y 19.8 (18.4) 28.3 (17.3) 17.4 (16.9) 6.1 (5.4) 130.4 (119.4) 267.6 (163.9)
>31 y 19.0 (17.0) 31.7 (16.6) 22.3 (20.4) 23.8 (29.1) 107.9 (116.0) 309.6 (213.7)
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Apr 13, 2017 | Posted by in Orthodontics | Comments Off on Orthodontic education programs: An international comparison of students’ views and experiences
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