Factors Influencing Dental Hygienists' Decisions to Pursue Doctoral Degrees

Interests and Characteristics of the Respondents

This study identified factors influencing dental hygienists to pursue doctoral education by comparing the responses of dental hygienists who had earned dental degrees (DDS and DMD) to those with academic degrees (PhD, EdD, and others). As both groups of respondents began careers as dental hygienists, they identified a number of shared interests and characteristics, ones that may have initially attracted them to the profession, such as working one-on-one with people as being important for their career satisfaction.

The survey questions also identified several parameters that distinguished respondents with dental degrees from those with academic degrees. First, dental respondents in this study were more likely than academic respondents to consider themselves mechanically inclined, defined as preferring to solve problems and work on projects that require building or repairing things with one's hands. This interest confirms results of previous studies.^1,10 In the study of career motivators for dental students conducted by Du Toit et al., “I like working with my hands and being artistic” was selected by respondents from 13 different countries.⁵ Job satisfaction has been shown to be related to the opportunity to use one's abilities,¹¹ and study respondents may have been piqued to pursue a dental degree by a desire to use their artistic abilities.

Another distinguishing characteristic between the groups was the academic degree respondents' preference to read about current research rather than to learn a new skill. It is likely that these respondents were actively involved with reading and evaluating current research studies throughout their doctoral educational programs. Furthermore, these activities and skills are fundamental to both teaching at institutions of higher education and conducting scientific research. In contrast, results of a recent systematic literature review of information-seeking behaviors of dentists indicated that dentists tended to adopt new materials and techniques after discussion with a colleague, a dental specialist, or a respected dental expert, rather than studying evidence-based resources,¹² which is in agreement with the findings of this study.

A desire to help people was a common interest of both groups in this study; however, there were remarkable differences to the approaches to this common goal. Respondents with dental degrees were in unanimous agreement about helping people by providing care on an individual basis, as supported by employment positions in private practice (65%) and in community clinics (21%). In a study conducted by Scarbecz and Ross, the third top reason for pursuing a career in dentistry for both males and females was a desire to treat or help people to improve their appearance,¹ and is reflected in other study findings regarding the employment settings of dentists and the provision of treatment on an individual basis.¹³

In contrast, academic respondents indicated a desire to help people by becoming involved in the education of future generations of dental professionals, as indicated by the academic institution employment settings of 96% of respondents of this study. Motivations for a faculty career for both groups of respondents may be similar. Research conducted by Gibbs and Griffin reported a desire to serve as a role model and facilitate the success of students as being a key motivator in biomedical science education.⁷ Although it was a smaller percentage when compared to the academic respondents, 43% of the dental respondents reported that they were also employed in academic positions. Intellectual challenge, research opportunities, and a desire to become a university administrator are factors identified in previous studies regarding dentists' career choices in academic dentistry.^14, Additionally, female dental specialists reported positive career and personal life balance found in academic dentistry.¹⁵

Helping people through involvement in policy decisions affecting society as a whole, was reported more frequently by academic respondents than dental respondents. Doctoral education may have helped prepare academic respondents to collaborate with other healthcare professionals in bringing changes through public policy.⁹ Dental hygienists with academic doctoral degrees may be able to help create healthier communities by conducting research and developing policies related to oral disease prevention and health promotion, a proposed program goal for a doctoral degree in dental hygiene.⁹

Dental and academic respondents in this study envisioned certain aspects of their work environment in similar ways. Both groups anticipated an affluent lifestyle contrary to the expectations that a greater percentage of dental respondents would indicate income as being a motive for pursuing a dental career.^1,3,4 Dental respondents in this study may have had more realistic expectations as compared to previous research.^1,3,4,11,16 A major difference between the dental and academic respondents was that more dental respondents indicate regular work hours as a career preference mirroring previous studies.^5,16 Regular working hours was ranked eighth out of the top 30 reasons for pursuing dentistry by both males and females.¹

Both groups in this study also agreed that they preferred an independent work environment; results which agree with previous studies of both dental and research-oriented students.^1,6 Dental respondents in this study also envisioned control of their work environment, supporting the findings of Chambers' review of job satisfaction in dentistry.¹⁶ Chambers identified typical job satisfiers in dentistry as being factors under their control, such as what goes on in their office.¹⁶ Other studies have identified specific aspects of control, including greater freedom and flexibility in scheduling their work.¹ In this study two-thirds of the academic respondents also envisioned control of their work environment. These respondents may have considered control of the work environment differently than dentists, possibly contemplating freedom to pursue research topics of interest ⁷ and being able to think or act independently with limited consultation or guidance from others,⁶ as suggested by previous studies.

Influential Persons and Experiences; Encouraging and Motivating Factors

Study respondents expressed receiving encouragement to pursue advanced education from various sources, only a small percentage reported internal motivation for earning their doctoral degree. Most had been encouraged to advance their education by a known individual. The importance of this key factor as a recruitment tool is evidenced by the statistically significant results that both the dental and academic groups of respondents had been encouraged to pursue the doctoral degree that they subsequently earned. Dentists appeared to be very instrumental at guiding dental hygienists and pre-dental students⁴ toward dental degrees. Approximately one-third of dental respondents in this study reported that a dentist or dental professional had been the most influential person in encouraging them to pursue a dental degree and that they had observed or worked with a dentist. These findings were supported by a study of predental students demonstrating that more than half of the respondents identified their family dentist as the professional who most influenced their decision to pursue dentistry.⁴ Another study of final-year British dental students indicated that work experiences and other encounters with dentists at work had been an important influence, particularly when the dentists appeared to find their work enjoyable or satisfying.³

While all of the respondents in this study had doctoral degrees, their parents had varying levels of education. This finding is of interest since parents have been shown to influence the level of education of their children,^17,18 regardless of their own academic achievements. Previous research has also shown that parents with advanced education may have set high aspiration and achievement standards for their children and served as academic or occupational role models.¹⁷ Conversely, parents without college degrees may have impressed upon their child the importance of academic achievements and their relationship to upward mobility with respect to a career. Of the respondents with academic degrees in this study, fewer than 10% indicated that a family member played an influential role in encouraging their advanced education. These results are consistent McGee and Keller's research on doctoral students' opinions of individuals who played critical roles in guiding their interests and career directions; very spoke of parents or other family members, whereas many referred to teachers, research mentors, and other role models.⁶

Of the respondents with academic degrees in this study, 43% reported having been influenced by an educator. These respondents indicated their agreement utilizing a Likert scale with the following survey statements: an educator was the most influential person; they were encouraged to pursue a doctorate in a subject area other than dentistry; and they experienced working with or observing a researcher or scientist before starting a doctoral degree program. Taken together, these statements point to the underlying importance of mentoring potential candidates for academically based doctoral degrees.

Relationships with Dental Hygiene

Respondents who had most recently graduated from entry-level dental hygiene programs were more likely to pursue a dental degree than an academic degree reflecting a classically held view that dental hygiene could serve as an introduction or foundation for dentistry.¹⁹ Dental degree respondents in this survey may have enjoyed the patient care aspect of dental hygiene, but felt dissatisfied or limited by the scope of practice or knowledge base. Data from this study indicate that the dental degree group may have been motivated to advance their clinical skills to gain a greater knowledge base of the options used treat and prevent oral diseases.

A greater percentage of academic versus dental degree respondents expressed dissatisfaction while working clinically as a dental hygienist, prior to their doctoral education. Low satisfaction was reported to be due to the lack of promotional opportunities and being treated subserviently; findings similar to previous studies, reporting dissatisfaction in clinical practice due to the lack of financial and career growth opportunities, insufficient communication with the dentist, and long work hours.^20,21

Dental hygiene educators carry the responsibility for teaching students the foundational knowledge and requisite clinical skills, however to advance the profession they also need to recognize the importance of mentoring. A mentor is defined as someone willing to share career experiences; a supporter who offers encouragement, provides performance specific feedback, and assists students to obtain opportunities.^22,23 Dental hygiene instructors as mentors could have a valuable influence on dental hygiene considering advanced degrees. Faculty role models have been shown to be pivotal in students career choices in research and academia.^14,24 An important finding in this study was that only 40% of all respondents agreed and 29% expressed being neutral regarding the role that their dental hygiene instructors had played in motivating their advanced education. Considering that the majority of entry-level dental hygienists graduate from certificate or associate degree programs, dental hygiene educators need to be aware of the importance of encouraging advanced education options. Pipeline programs and early outreach efforts in regards to academic careers have been shown to be effective recruitment strategies.²⁵

Ongoing discussions on the value and benefits of advanced education during entry-level dental hygiene education may serve to encourage and motivate future graduate students.⁹ Duties and career choices within dentistry are well known, especially to those with family members in the field. Dental hygienists exploring options for advanced education may choose dentistry based on its familiarity. Integrating dental hygiene-based research into classroom experiences that can be linked to more detailed descriptions of the different types of doctoral degrees and their applications can inspire students to think of multiple opportunities beyond clinical practice. Research conducted by Boyd and Bailey demonstrated that one-third of their respondents were unclear regarding the opportunities and value of obtaining a graduate degree in dental hygiene and therefore were reluctant to pursue graduate education.²⁶

Early exposures or encounters have been reported to influence thoughts on pursuing graduate education. Findings from Smith et al.'s research-doctorate pipeline initiative showed that students do not know where their interests lie unless they have been exposed to new opportunities.²⁷ Another study conducted with undergraduate nursing students identified as having no interest in research, showed that after engaging in meaningful research activities, students reported enhanced research interests, which subsequently influenced their future career plans.²⁷ Entry-level dental hygiene students could be introduced to the research process by teaching them skills in searching and evaluating the literature, requisite to adopting an evidence-based approach to patient care and graduate programs could create opportunities for dental hygiene master's degree students to participate in on-going studies, conducted by established researchers.²⁸ Increased numbers of dental hygienists with experience in the research process are needed to play this critical role in dental hygiene education and advancement of the profession. The development of a research-based doctoral degree program in dental hygiene would be advantageous to increase the number of dental hygienists with academic doctoral degrees to fulfill this role.⁹

Limitations

The unequal number of respondents in the academic and dental doctoral groups limited the findings of this study. While the number of potential participants were similar for both groups, more dental hygienists with academic degrees responded to the survey. Respondents from the academic group may be actively involved in dental hygiene education and recognize the importance of doctoral education for the advancement of the profession, resulting in a response bias. A second limitation was that the survey items relating to motivating factors were more descriptive of the practice of dentistry than academic interests. Items including increased knowledge, professional advancement, and intellectual challenge, which are more related to academic career choices, could have been included. Also, responses to survey items regarding the most influential person may have been dependent upon the respondent's interpretation of the term educator, that was assumed to include a dental hygienist/instructor. Qualifying terms to differentiate educators as dentists from dental hygienists were lacking, as well distinctions between dentist/dental professionals who may or may not have been educators. Considering that 25% of the dental respondents were also recent dental hygiene graduates, the 71% who selected observing or working with an educator may have been referring to instructors in their dental hygiene educational programs, which would have included both dentists and dental hygienists. If the term educator had specified non-dentist, the percentage of dental respondents selecting educators may have been lower.