Female dental students' perceptions on barriers and motivators in pursuing oral and maxillofacial surgery

Abstract

Purpose

Although females represent more than half of US dental students, less than 10% are practicing oral surgeons. This study sought to identify barriers and motivators perceived by female dental students in their D1 and D4 years concerning a career in oral and maxillofacial surgery (OMS).

Methods

This cross‐sectional study used a single survey in 2023 sent to all US dental schools for female D1 and D4 students. Perceived barriers and motivating factors were rated on a scale from 0 to 5, 5 indicating the highest importance. For comparisons between D1 and D4, the data were analyzed using the Mann–Whitney test and adjusted for multiple correction using the Bonferroni method. All responses were pooled to identify statistically significant barriers and motivating factors.

Results

Combined cohort barriers identified were time commitment (86.2%), family sacrifices (75.2%), long work hours (70.7%), and need to perform at top of class (64.6%). The important motivators were financial security (82.1%), scope (71.2%), respect (62%), and lifestyle after residency (51.4%). A statistically significant difference between groups was on the need to excel academically, with D1 students rating it more important (4.14/5) and D4's rating 3.51/5 (adjusted p‐value = 0.02, which is less than 0.05). The responses for motivation to pursue OMS showed a significant difference, D1 rating it 3.81/5 and D4 rating it 3.26/5 (adjusted p‐value = 0.03, which is less than 0.05).

Conclusion

As the primary barriers identified relate to issues of time and personal sacrifice, it may be beneficial to enhance female mentorship and surgical clerkship opportunities for female dental students to address these issues.

1. INTRODUCTION

The number of female dental students in the United States has been on the rise, and in 2021, for the first time, a greater number of women graduated from dental school compared to their male counterparts. ¹ , ² This should not be surprising as survey studies conducted in the 2000s indicated that females are attracted to the field of dentistry due to the motivating factors it provides for patient care, financial stability, and flexibility for family commitments. ³ , ⁴ Today, women continue to represent the majority of students in dental schools and the America Dental Association predicts by 2040, the majority of dentists in the United States will be women. ² However, female representation in the field of oral and maxillofacial surgery (OMS) remains disproportionately low. Presently, females constitute less than 10% of all practicing oral and maxillofacial surgeons and approximately 21% of OMS residents. ⁵ While 21% is an upward trend, the representation of females in residency training remains significantly lower than that observed in other accredited dental specialties. ²

This raises the question: why are women underrepresented in this specialty? Results from 1990s survey studies showed that the majority practicing female oral and maxillofacial surgeons had achieved family aspirations and were successful financially. ⁶ , ⁷ If the personal and professional accomplishments attained following oral and maxillofacial surgical training align with the motivations for entering the field of dentistry, what obstacles hinder female dental students from considering this specialty?

There are numerous published papers highlighting this same topic in the medical literature. Selected reasons that influence female students’ decision to enter medical surgical specialties include lack of mentorship, limited exposure during medical school, characteristics of the surgical field, gender discrimination, and individual circumstances. ⁸ , ⁹ , ¹⁰ , ¹¹

The importance of these survey studies is the impact for change. Medical surgical training has seen results with programmatic improvements such as flexible family leave, initiatives aimed to reduce the stigma associated with pregnancy, eradication of gender discrimination, facilitation of early connections between medical students and role models, and establishing outreach programs tailored for women that bolster interest in surgical careers among female students. ⁹ , ¹²

The existing dental literature on this subject is evolving, yet remains limited. Previous research has identified several barriers, including time commitments, family obligations, experiences of sexual harassment, and insufficient mentorship. ¹³ , ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ These studies have surveyed surgical residents and dental students. However, to date, there are no studies that exclusively examine the perspectives of dental students, particularly at the onset of their academic journey.

This survey study investigated the perceptions of female dental students in their first (D1) and fourth (D4) years regarding the specialty of OMS. We hypothesized that both cohorts will have similar beliefs, but the less experienced dental student may identify barriers such as gender discrimination and insufficient mentorship as the most significant challenges. In contrast, the senior student may perceive family obligations and time commitment as substantial deterrents to pursuing a residency. Lastly, we believed that both cohorts will view the scope of practice and the recognition of performing surgery in a hospital setting as motivator factors. By identifying the barriers and motivators perceived by female students, particularly at the beginning and conclusion of their dental education, the authors aimed to use these insights to develop targeted strategies that will increase female enrollment in the specialty.

2. MATERIALS AND METHODS

2.1. Study Design/Sample

The research proposal was approved by the Institutional Review Board of The Ohio State University (Columbus, OH). An electronic cross‐sectional survey study was developed using the Qualtrics survey platform (https://www.qualtrics.com/; Qualtrics). The survey was emailed to the Deans of all accredited dental schools in the United States during the academic year of 2022–2023. The inclusion criteria consisted of female dental students who are currently enrolled as either D1 or D4 student in an accredited predoctoral dental school in the United States, recognized by the Commission on Dental Accreditation. The exclusion criteria included individuals who did not consent to participate in the survey, male students, and nonbinary students, which resulted in the automatic termination of their responses.

The questionnaire used in this study comprised questions designed explicitly for participants. The first questions were optional which inquired about the participants’ demographic information, such as age, marital status, and dependents.

The mandatory questions were closed ended and categorized into two sections with the first focusing on perceived barriers and the second being topics of motivators. The answers were recorded using a sliding scale from 0 to 5, with 5 being the strongest concern and 0 being of no concern. Each question included a free‐response to provide respondents an opportunity to provide further insights not able to be captured in the closed response.

Barrier and motivator questions were chosen to follow previous reported studies in the medical surgical literature. ⁸ , ⁹ , ¹⁰ , ¹¹ , ¹² The topics were narrowed to common preconceived negative concerns with surgical training including extended work hours, male dominance within the field, and the challenges posed to family planning (Table 1). ⁹ , ¹² In addition to identifying the barriers that female students may perceive, questions regarding their motivating factors were also included. As females are drawn to dentistry for reasons such as financial stability, family considerations, and the desire to help patients, the questions selected for this category reflected these themes. ⁴ Furthermore, since OMS offers the unique opportunity to practice beyond the traditional boundaries of dentistry and within a hospital setting, questions focusing on this aspect were also included (Table 2). To determine commonalities among the D4 women who disclosed they were applying or had already applied to OMS residency, an additional question set was populated on the survey regarding their experiences prior to applying (Table 3). The anonymous survey responses were collected via email, with three reminder emails sent at 2‐week intervals to boost participation. After 6 weeks, the results were organized in a spreadsheet for statistical analysis.

TABLE 1.

Questions in the online survey targeting perceived barriers.

	Survey questions focusing on perceived barriers Five‐point scale ranking answers from 0 (no concern) to 5 (strongest concern)
1.	Do you currently have or previously had a mentor from a nonoral and maxillofacial surgeon dentist?
2.	Do you currently have or previously had a female oral and maxillofacial surgeon mentor?
3.	Are you currently given the opportunity or had the opportunity to observe female oral surgery residents and faculty in their daily routines?
4.	Have you attended or been able to attend oral and maxillofacial surgery meetings either local or national?
5.	Have you attended or been given an opportunity to join women‐specific oral and maxillofacial meetings?
6.	Do you have a concern regarding females working in a male dominant in field?
7.	Do you have a perception that males display gender bias in the field?
8.	Do you have an expectation of long work hours during residency training (daily work hours)?
9.	Is it a concern that you will be required to commit another 4–6 years of postdental training (time commitment)?
10.	Do you have a concern regarding limitations of having children and family during residency (family sacrifice)?
11.	Do you have a concern regarding limitations on social life during residency?
12.	Do you have a concern regarding increased liability with job duties?
13.	Do you feel there is an expectation to perform at top of class each year?
14.	Do you have a concern regarding the requirement to study and take a separate board examination (CBSE)?

TABLE 2.

Questions in the online survey targeting perceived motivators.

	Survey questions focusing on potential motivating factors Five‐point scale ranking answers from 0 (no interest) to 5 (strongest interest)
1.	Do you consider the opportunities for financial security as a motivator to pursue oral and maxillofacial surgery (OMS)?
2.	Do you consider the ability to perform advanced maxillofacial surgical procedures (scope of practice) as a motivator to pursue OMS?
3.	Do you consider the opportunities for medical training and fellowship as a motivator to pursue OMS?
4.	Do you consider the lifestyle of being a female oral and maxillofacial surgeon as a motivator to pursue OMS?
5.	Do you consider the ability to work in a hospital setting and have respect of surgical peers as a motivator to pursue OMS?

TABLE 3.

Questions specific to female D4 students who had applied to oral and maxillofacial surgery (OMS) residency.

	Y/N specific questions to D4 female students who applied to OMS
1.	Did you have a dentist mentor?
2.	Did you have an OMS mentor?
3.	Did you have a woman OMS mentor?
4.	Were you aware of any women OMS specific events or conferences?
5.	Did you participate in any women OMS specific events or conferences?

2.2. Data Analyses

For any comparisons between D1 and D4 cohorts, data were analyzed using the Mann–Whitney test and adjusted for multiple correction using the Bonferroni method. All responses were pooled to identify statistically significant barriers and motivating factors.

3. RESULTS

Of the estimated 6700 D1 and D4 women dental students in the United States, 338 completed this survey, representing 5% of the total. There were 223 individuals from the D1 cohort and 115 individuals from the D4 cohort. To emphasize relevant data, only the questions with greater than 50% of respondents choosing “strongly agree” are shown as a combined results in both Figures 1 and 2.

FIGURE 1.

Combined D1 and D4 top perceptions of barriers to oral and maxillofacial surgery (OMS) as a career.

FIGURE 2.

Combined D1 and D4 top motivators to oral and maxillofacial surgery (OMS) as a career.

When comparing the responses of D1 and D4, two items exhibited significant differences: one barrier and one motivating factor. The barrier that showed a statistically significant difference was the need to perform at the top of the class. D1 rated this factor as more important, scoring 4.14 out of 5 on the 5‐point scale, while D4 rated it at 3.51 out of 5 (adjusted p‐value = 0.02, which is less than 0.05). Additionally, the motivating factor of lifestyle after residency also demonstrated a significant difference, with D1 rating it at 3.81 out of 5 and D4 rating it at 3.26 out of 5 (adjusted p‐value = 0.03, which is less than 0.05).

There were only nine of the 115 total D4 women who applied to OMS residency, their responses were as follows in Table 4:

TABLE 4.

Specific D4 student responses.

	Y/N specific questions to D4 female students who applied to oral and maxillofacial surgery (OMS)	Y	N
1.	Did you have a dentist mentor?	9	0
2.	Did you have an OMS mentor?	9	0
3.	Did you have a woman OMS mentor?	4	5
4.	Were you aware of any women OMS specific events or conferences?	7	2
5.	Did you participate in any women OMS specific events or conferences?	5	4

Students were able to provide open‐ended responses to several selected questions that broadly addressed the targeted inquiries regarding barriers and motivators. Out of the 338 responders, only 9.5% utilized this option. Some of the responses involved the same theme, which are summarized in the following Tables 5, 6, 7, 8, which distinguish between the D1 and D4 responses.

TABLE 5.

First category of open‐ended question responses.

Open‐ended answers
What resources could help female students explore oral and maxillofacial surgery (OMS) as a career?
D1 More mentorship and clerkship opportunities Ability for female OMS residents to speak with students Scholarship opportunities for pursuing OMS Presentation of the pros and cons of pursuing OMS pathway given by female residents First‐year aptitude test to help students determine their interest in OMS Opportunities to speak with practicing female OMS What does work life balance detail? Are women able to engage with their family during and after residency? Is gender equality evident?
D4 Identifying OMS programs that accommodate family life in residency

TABLE 6.

Second category of open‐ended question responses.

What other barriers do you perceive that were not asked?
D1 Insufficient school support and administration Confusion regarding the CBSE grading system Perception that oral and maxillofacial surgery (OMS) residents are not treated well in the hospital Minimal support for mental health and well‐being Field that is predominantly Caucasian Unappealing arrogance of OMS faculty
D4 Loans Managing working with an egotistical male OMS OMS faculty having no involvement with students Women are assigned simpler cases in dental school, assume the same for OMS Geographical location of residency programs Earning potential appears no different than a full‐scope general practitioner

TABLE 7.

Third category of open‐ended question responses.

What motivates female students to apply to oral and maxillofacial surgery (OMS)?
D1 Ability to work in public health clinics as a surgeon To dominate as a female in a male dominant field Expand diversity in surgery
D4 Ability to financially provide for a family Opportunity to be a female mentor post‐OMS training Rewarding career as surgery can change lives Surgery is more interesting than general dentistry

TABLE 8.

Fourth category of open‐ended question responses, D4 only.

Why did choose not to pursue oral and maxillofacial surgery (OMS) (D4 only)

Length of training and time commitment Studying for the CBSE Perception that field is not family friendly Desire to have a dental practice that is broad scope Unappealing to travel for externships Limited support and exposure during dental school Perception that OMS only do extractions and implants after 4–6 years of intense surgical training Culture is very toxic at current dental school Limited female mentorship

4. DISCUSSION

Survey studies conducted several decades ago suggested that the field of dentistry will be increasingly desirable to females because of the financial stability and the potential for work–life balance it offers. ³ , ⁴ These theories have been validated, as female students outnumber males across the nation over the past 5 years. ² Nevertheless, the field of OMS continues to exhibit a disparity in gender equality, despite practicing female oral and maxillofacial surgeons demonstrating great success in family and financial aspirations. It is reasonable to speculate that the perceived barriers to pursue advanced training in OMS may offset the rewarding factors after completion of residency. The findings of this investigation seek to examine the perceptions of female dental students, with a particular focus to evaluate possible differences in the interpretations between first‐year and fourth‐year students.

Not unexpectedly, our hypothesis and results largely align with those of previous survey studies that identified time commitment and compromised family/social life as the most substantial deterrents for both cohorts. ¹⁵ , ¹⁸ Additionally, our study identified another notable hurdle not discussed in previous papers, which was the pressure to perform at the top of the class. This predictable finding, while statistically significant for D1 students, represents a noteworthy source of stress for all dental students, not just for females pursuing a specialization in OMS. Remarkably, contrary to previous research results and our hypothesis, and in addition to common negative perceptions regarding male dominance in surgery, neither cohort of female dental students viewed gender bias as an obstacle to pursuing a career in OMS. ¹⁹

One of the more intriguing findings emerged from the analysis of the motivating factors. The authors proposed that the positive recognition associated with performing complex maxillofacial surgeries in a hospital setting would motivate both cohorts to pursue a career in OMS. Our results indicate that students perceive the financial security associated with a career in OMS as the most significant motivator. Additionally, the respondents highlighted respect and lifestyle after residency as important factors as well.

Only nine students applied to OMS residency, totaling 7.83% of the D4 respondents. When analyzing the yes/no responses of this specific group, all indicated having an OMS mentor, however, less than half had a female OMS mentor. The significance of mentorship, irrespective of gender, aligns with findings from a prior study conducted by Scarbecz and Ross, ⁴ which indicated that dental students regarded mentorship as a vital factor influencing their decisions regarding postgraduate training. Conversely, the medical literature reveals a slight divergence, as female medical students have identified same‐gender mentors as essential for their motivation to pursue surgical residency. ²⁰ , ²¹

There were two unique aspects to our study. First, our survey included all female dental students, not just those applying to surgery. The second was the open‐ended response section following each question, which allowed female students to express any additional thoughts they felt were necessary. These themes were consistent with medical literature including responses such as “females are often assigned less complex cases in dental school” and “family sacrifices for pursuing a surgical career” as major barriers. ¹² While these responses could not be quantitatively analyzed, they are noteworthy and highlight considerations beyond what previous survey studies have found thus far.

The purpose of collecting these data is to recognize the obstacles that female dental students encounter, with the intention of increasing their interest in pursuing a career in OMS. An effective strategy for addressing the survey results is to focus on the most important barriers that female dental students face regarding the lifestyle balance of residency and future practice as oral and maxillofacial surgeons. This can be achieved by incorporating community and private practice experiences. Early opportunities to engage female students during the D1 year may demonstrate that female oral and maxillofacial surgeons have a secure and stable lifestyle. With the survey results indicating no statistical differences between the D1 and D4 classes in respect to the primary barrier of time commitment and family sacrifices required, addressing these concerns at any point before applying to residency would create the most optimal experience to overcome these challenges. For example, medical schools have incorporated clerkship experiences within private and community practices. Students who have engaged in these environments have demonstrated an enhanced appreciation for a potentially improved work–life balance and have exhibited a heightened interest in pursuing surgical careers. ¹² Therefore, tackling these concerns in a real world opportunity would create an optimal experience to alleviate their apprehensions.

In addition to clerkships, formally matching female dental students with surgical role models of any gender, including attending physicians or surgical residents, as early as in the D1 year could be helpful. Despite the survey not recognizing this as being as important as time commitment and family sacrifices, having a female mentor may foster an engaging connection beyond the clerkship experience. ²⁰ , ²¹ It is advisable to encourage students to pursue mentorship opportunities through national organizations, such as the American Association of Oral and Maxillofacial Surgeons (AAOMS), which has established a mentorship program specifically designed for female dental students.

There are limitations to our study including the reliance on subjective data and presence of a low response rate, which is common when surveying doctors. This survey is also at risk of sampling bias, as those D4 females who did choose to pursue OMS residency may be more inclined to complete a study related to OMS as compared to their counterparts.

5. CONCLUSION

The significance of this study lies in its potential to promote future change. Our findings underscore the importance of providing mentorship to female students from female oral and maxillofacial surgeons. This is particularly crucial in helping them navigate the balance between time commitments and family planning. Focusing on specific barriers may be more effective than providing support in areas that are less significant to students. Furthermore, initiatives aimed at increasing networking opportunities for female dental students with female oral and maxillofacial surgeons must engage both academic and private practice surgeons. These efforts have evolved in the past 5 years, but must increase to encourage the new generation of surgeons.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Jatana C, Conley K, Moffitt A, Schumacher F, Emam H. Female dental students' perceptions on barriers and motivators in pursuing oral and maxillofacial surgery. J Dent Educ. 2025;89:1187–1193. 10.1002/jdd.13826