A Review of the Description and Measurement of Qualifications for Dentistry and Dental Training
- Author:
Richard S. Schultz
The Psychological Corporation
New YorTc City.
Publications directly bearing on this problem are few and scanty. The various topics included in this paper, however, appear to give a general survey of the research problems and trend of investigations in this field.
Historical
Historical sources reveal that a training device was actually used for testing ability in extracting teeth by the ancient Japanese dentist. “He learned to extract teeth by first being given a board into which a number of pegs had been driven, which he learned to extract with the thumb and index finger only. These pegs were of different sizes and shapes, and were driven into the board tighter and tighter until he who could extract them deftly was able also to ‘pull’ teeth in the like manner” (20).
About 1700, efforts were made in France to set up standard qualifications for dentists. Pierre Fauchard (father of modern dentistry), in 1728, gave an account of what may be done with the teeth, showing an attempt at job analysis, finally ending up with a statement of the qualifications for dentistry?”all of these operations (dental) demand a skillful, steady and trained hand and a complete theory” (20).
The early training of dentists was by apprenticeship. Many dentists had no specific training. Any one who cared to ‘pull’ teeth and perform other surgical operations was at liberty to do so. We thus find goldsmiths, barbers, blacksmiths, even one of historical fame (Paul Revere), and others who possessed “good strength” practicing dentistry along with other vocations.
In 1840, the first dental school was opened in Baltimore. This event has been considered as the beginning of dentistry as a pro172 fessioxi. Many schools opened in the following years, so that during a subsequent period of years, there was an overabundance of practitioners who had received diplomas certifying qualifications; but the schools from which they came were of doubtful standard (6).
Throughout the latter part of the 19th century, and more so now, strong efforts were made by associations of dental teachers and dentists to raise the educational standards, to improve the curriculum, to devise some standard qualifications for dentistry, as well as to set up entrance requirements and qualifications for students contemplating the study of dentistry (1, 6, 10). The earlier selection of dental students was usually based on ability to pay the tuition fees. However, the later efforts have been to inquire into the students’ experiences, interests, educational background, as well as to make some personal judgment of capabilities, and in a few instances recently, to venture aptitude tests.
Qualifications of the Dentist
The professional and educational literature in dentistry emphasizes repeatedly that a dentist should possess many qualifications of a varied nature (1, 6, 10). But the most important qualifications stressed are: ” mechanical ability,” “manual dexterity,” “finger power,” “skill,” “eye-muscle coordination,” and many similar traits. All of these statements reveal the most important qualification of the dentist?the ability to work with his “hands” efficiently. The dental student spends more than half of his curriculum hours working with his hands; while the dentist certainly spends a greater part of his time in much the same manner.
In 1889, before the British Dental Association, a very excellent paper was given on “Finger Training in Dentistry” (17). A comprehensive analysis is made of the necessity for training in manumotor skills and coordinations, and of their relation to effective operations on the teeth. Various traits and qualifications of the dentist are indicated. A criticism is made of the too intensive subject matter training and of the too little stress on the necessary “mechanical” training. The student crams his head full of facts, rehearses, learns, and has sufficient knowledge of the theory, but overlooks the necessity of application in the same manner to the “mechanical” side of his education. Environmental influence, interests and original capacities for motor and mechanical skill are also discussed.
An influence which has directed the professionalization and scientific trends in dentistry, is the work of Dr 6. V. Black. Through many pages in his texts and other publications, he dwells on the psychology of the patient, and indirectly reveals many necessary qualifications. A very complete analysis is made of the importance of vision to success in dentistry.
In order to obtain some facts on “finger power” as related to mechanical and operative abilities of dentists, Dr Black devised a “Dentist’s Manudynamometer.” This instrument is based on the usual dynamometry principles. The subject is asked to take hold of a stylus in particular finger grasp styles and to thrust at a small disk; the movement of this disk, as well as the amount of force or pressure exerted, is recorded graphically. With this device it was possible to study the effectiveness of certain instruments, to analyze the strength of thrust of dentists and dental students, and to make a study of skill and finger power.
Facts and figures are cited to show the value of the manudynamometer. “The range of differences between men, in power of thrust with the pen grasp, runs from 5 to 35 pounds, with the average about 15 pounds, as shown by numerous tests made at meetings of dentists. It seems very curious to find large muscular men with feeble finger power. A man’s general muscular development is no index to his power of handling delicate instruments.” … “Much careful observation has shown conclusively that delicacy in the accurate control of instrument is very generally an accompaniment of a high degree of finger power.” … “An experience of over ten years in taking these measurements shows that much increase in finger power, as well as delicacy of movement, can be acquired by careful training, and also that it is easily lost by careless habits.” Averages are cited for a class of 160 dental students who gained in “finger power,” through careful training; in the first year 9 pounds, second year 13 pounds, and third year 17 pounds. But some students lost “finger power” through “careless habits,” and one student doubled his power by constant practice (4).
3. Methods of Industrial Psychology as Applied to Dentistry A paper published in 1926 gives a very brief analysis of the practicing dentist’s job. Efficiency methods, photographic movement studies, outlay of office and work apparatus, division of labor, and better working conditions at the chair are suggested (9). W. Baiters has made a very detailed analysis of the dentist at work along the lines indicated in the preceding study. Many traits are analyzed in detail in accordance with the orthodox psychological categories. The list that follows represents a summary of special aptitudes and traits that appear significant, to this investigator, for success in dentistry: ability to observe mental reactions; imageability of spatial arrangement; skill of hand; aptitudes for technical knowledge; mechanical intelligence; special ability for line, area and space form; aesthetic sense; general ability for repetitive performance; practical ability; quick judgment of situations; social intelligence; organizability; business sense; technical dexterity for drawing, photographing, and statistical representations (3).
Experimental Investigations
“Fifty seniors and thirty freshmen in a Dental School (University of Denver) were studied as to age, average grades, and test performance in Army Alpha and in the Downey Will-temperament tests. The seniors were also rated by their instructors as to possible success in Dentistry” (18). Intelligence score correlated -f- .41 with grades and -f- .26 with estimated probable success of seniors. For freshmen the correlation between grades and Intelligence test score was -f- .40. ‘’ The Will-temperament test, grouped, correlated significantly with grades of freshmen, but not with grades or estimated success of seniors.” … “Apparently the age of seniors is comparatively unimportant, the coefficient of correlation with grades being ? .204 and with rank -(- .166. However, the freshmen correlation -f- .476 of age with grades indicates a tendency for the older men to have a better chance to handle the work in the first year.’’
Scores obtained for the Army Alpha Intelligence test, at the University of Denver, when compared with the Army data and Fryer data reveal slight differences in range and central tendency. The results for the University of Denver are: Freshmen: entire range?61-180, average?123.62; Seniors: entire range?33-153, average?112.85; as compared with the Army data: middle 50 per cent?84-130, median?106; and Fryer: score range?80-128, average?110 (16). The intelligence of dentists as compared with other occupations ranks high in the Clerical and semi-professional group according to the Army data. Another relative position of dentists is revealed in the following order (from high to low) of occupations receiving a B rating in intelligence, by Fryer,?Physician, Teacher (public schools), Chemist, Draftsman, Y. M. C. A. Secretary, Dentist, Executive (minor).
An investigation by the present writer 1 indicates a low consistent relationship between performance in a task involving quick and effective adjustment to a relatively novel motor situation (Miles Two-Story Duplicate Maze) and ability in dental technical courses. Scores in a general intelligence test appear less significant. In both of these tests the average score for dental students is superior to ‘’ unselected” groups of college students (21).
Marbe reports an investigation at the Wurzburger Dental Institute. Four tests, requiring about one half hour total performance time, were used to measure the essential aptitudes for dentistry. These are as follows:
1. A Wire lending test for manual dexterity, observation, visual space discrimination, form sense, judgment of direction and personal tempo;
A Pearl stringing test for manual dexterity and personal tempo;
A Tremometer for steadiness;
4. A Pea test (dropping three peas into a tube from a glass half full) for manual dexterity, foresight and care.
A final correlation between the ranking of 13 ‘’ Praktikanten” by one professor and average test rank performance was -j- .60. One student was so poor and fell so far out of the range that he was eliminated. The correlation for the group was thereby raised to -f .83. In another experiment, using the same 12 subjects with 8 others, rankings were obtained from three instructors. The correlations between the respective rankings and test performance were -f- .83, +.83, -j- .73 (13, 14, 19).
At various times American psychologists have been interested in or asked to carry out investigations in the Measurement of Abilities for Dentistry. An address by C. E. Seashore on ” Selection of Students for Technical Courses” is summarized thus: “A lengthy discussion followed on the desirability of intelligence (placement) tests for students wishing to matriculate in dental schools. The gist of it was that such tests are of great value in eliminating the unfit. Seashore especially emphasized from his experience the reliability of findings as to least well qualified 10 per cent of the freshmen group” (10).
i To be reported in a later issue of this journal.
G. M. Whipple mentions in a brief note an attempt made by a graduate student under his supervision at the University of Michigan to use the standard tests such as steadiness, aiming, tapping, etc., in “Diagnosing Operative Skill in Dentistry.” The outcome of this investigation, which was never fully completed, was that’’ of the various tests employed one completely separated the two groups (i.e., good and poor ratings in operative skill), namely, the seemingly naive test of sharpening a lead pencil” (24). A number of investigations are in progress in the Dental Schools. Various qualifications are being studied by means of rating scales, interviews, questionnaires, interest analyses, intelligence tests, motor and mechanical tests, academic records, and personal data. Unfortunately, this information is not available at present for publication.
5. Vocational Information and Personal Data An investigation made by R. B. Cunliffe through the use of a questionnaire and the study of personal records on the choice of a vocation of college students shows these important facts. The intelligence of dental students is lower than that of any other professional group except Pharmacy; in the homes where a foreign language is spoken fewer tend to choose dentistry; and the highest proportion of fathers in the unskilled trades is found among students choosing dentistry (8).
The results of a questionnaire study by E. S. Jones, involving 32 dentists near Buffalo, are especially interesting. Only 3 out of 32 had a B.A. degree before beginning to study dentistry. As to extra-curricular activities, 25 per cent stressed summer vacation work along dental lines?such as dental assistants, or as university laboratory assistants. This group does not seem to feel the need for a four-year pre-dental training (12).
The average estimated income between 35 to 40 years is about $9,000 a year. Dentists seem to reach their maximum a good deal earlier than lawyers or physicians, but it is possible that they do not continue to practice as long as the other two groups. There is a marked preference for specialization, and closer relationship with medical knowledge.
Of the special qualifications for Success in Dentistry, the preferences based on the judgments of the 32 dentists are as follows: Mechanical aptitude 25 (78%)2 Selling ability 22 (69%) Poise and self control 21 (66%) Optimism and kindliness 21 (66%) Energy and vigor 16 (50%) Ability to organize 10 (31%) Other qualifications mentioned are perseverance, cleanliness, and good health. ‘’ Good health is mentioned more frequently than any other trait; this is indicative of the confining nature of the work, and no one should consider this profession who is nervously unstable. There is a high rate of physical breakdown for this occupation.’’
An annotated bibliography published by the University of Michigan cites many important references to descriptive literature on dentistry and the experience of dental practitioners (15). In line with the above specific reference to the health of the dentist is the following compact and significant abstract on occupational diseases of dentists. Among occupational diseases, in addition to specific eye defects, may be mentioned wounds of the fingers by bites, dermatoses caused by frequent washing of the hands with sublimate of mercury. By overexertion of certain muscles used in dental work neuroses may be caused, while conditions such as genu valgum (knock-knee) and genu varum (bowleg) may be produced by long hours of standing. The position of the dentist at the operation chair sometimes leads to scoliosis, and flat foot may develop as a sequel to relaxation of the muscles and ligaments. Varicose veins are also very common (2, 4, 11).
Methods of Selection in Dental, Schools
It was necessary to communicate personally with a representative number of dental schools in order to obtain information on the methods of selection of dental students.3 The results of this inquiry are very promising. Although many of the dental schools furnished information, they necessarily avoided giving details. Programs of research on methods of selection and qualifications are reported as too incomplete and tentative. The information is, therefore, restricted. As a statement of the existing situation and 2 Percentages computed by the present writer.
3 The writer is indebted to the Deans of the many Dental Schools, particularly to Dr Alfred A. Owre, Columbia University, and Dr Charles R. Turner, University of Pennsylvania; and others who have made this information available. as evidence for the necessity of an extensive scientific program, the brief survey that follows is very pertinent.
(a) Academic Record in a Method of Selection Many of the Dental Schools do not reveal a critically objective plan of selecting students. The usual procedure is to have the prospective student submit his academic record (sometimes an accompanying photograph) ; perhaps a letter of recommendation from a teacher, dean, or other person; and in some cases a personal interview is requested before final decision is made on the applicant. This method of selection is based principally on the grades of the student and whether he has taken the prerequisite courses. The final action on the applicant is made by the Dean, or by the Dean with the aid of an Admissions Committee.
(b) Technical Course Prerequisite in a Method of Selection Some Dental Schools have set up technical pre-dental requirements as a basis for selection of students. They require that each prospective student present evidence of having passed a course (usually similar to the courses given in the Engineering Schools) in Shop Practice or Manual Training, and Mechanical or Freehand Drawing. One school finds it advisable to include a course in Drawing and Shop Practice consuming 10 per cent of the total number of hours in the first year dental course. Other schools merely state that it is preferred that students have had these courses but “the faculty may accept electives” for these courses. This method is not unlike the above except for the added precaution. It has been commented upon favorably by many dental educators. An assumption, however, seems to be made in this method of selection, that training for general skills has a high relationship to the very specific aptitudes necessary for success in dental training. One significant step is taken in this method. It recognizes that there are other factors to be considered in addition to academic achievement in the selection of dental students.
(c) Basic Training in Dental Technology as a Method of Selection Two outstanding attempts have been made to deal with the problem of basic courses pertinent to the skills necessary for success in dentistry. The University of Buffalo conducts a special three-week course in “Pre-dental Technology?primarily facility in using tools, and in wire bending and the like (5). The purpose of this course is “to test not scholastically but practically their aptitude for success in Dentistry.” … “No academic credit is given for this pre-dental course, and those in whom it discloses lack of the appropriate skill will not be admitted to the pre-dental course of the arts college.’’
This plan is a significant forward step in the direction of placing the selection program at the time when the student makes a vocational decision. It should possibly avoid belated disappointment and save two years or more for the unsuccessful candidate. A more extensive course, stressing the training rather than the “testing” in basic aptitudes necessary for success in Dentistry, is given at the University of Toronto. “A course is given in the principles of Dental Technology, with laboratory classes, for the purpose of instructing students in technical procedures and, commencing even at the early period (first year in a five-year course), to train them in digital skill.” This course consumes about 8 per cent of the total number of curriculum hours. Another first year course, in Drawing, takes up over 6 per cent of the curriculum hours (22, 23).
An analysis has been made, at the University of Toronto, of the basic “motor and mechanical” aptitudes and skills necessary for success in practical dentistry and research. The entire course has been analyzed into 172 separate operations. This may serve as a basis for further Job Analysis as well as for indicating essential abilities (23).
(d) Aptitude Tests in a Method of Selection There are no Dental Schools known to the writer at present that have promulgated a definite program based on the standardized procedure and scientific methods of Vocational Psychology for the selection of dental students.
The information that is available from two schools, in which aptitude tests are used, is presented in detail. The method of selection in one school has the basic possibilities for the development of a scientific program. The procedure is based on three measures. An intelligence test is given to all students. This examination is used as a guide to instructors and not as a basis for elimination of students. Scholastic achievement in pre-dental courses is the second measure and serves as a critical score for eliminating students. Finally there is an aptitude test. This “is more of a measure of artistic and mechanical ability,” in a task involving freehand carving, which is obtained after the student has been admitted. Thus, it appears that students are selected, as in the other methods mentioned, primarily on the basis of academic achievement.
Columbia University, School of Oral and Dental Surgery, states definitely in its descriptive catalogue that a Dental Aptitude Examination is one necessary prerequisite for admission. ‘’ The entire pre-dental record of each student is carefully examined by the Committee on Admissions in order that those who are judged most capable of meeting the exacting demands of the course and of the profession of dentistry may be selected.
‘’ In order to make the best selection from among the candidates who are eligible for admission, all applicants who are eligible will be asked to report at the Dean’s office for a personal interview sometime prior to final action of the Committee on Admissions. Those who remain on the eligible list after a personal interview will be given an examination as to mechanical ability and manual dexterity. It will consist of exercises in mechanical and freehand drawing, metal filing, and moulding in plastic material and will be conducted by the technic teachers in the school” (7).
Bibliography
Amer. Assoc. Dental Schools. Proceedings, 3d Annual Meeting, 1926.
2. Anon. Note on Occupational Diseases of Dentistry. Dental Record, 1929, 49, 524. 3. Balters, W. Psychotechnik. Die Fortschritte der Zahnheilkunde. 1925, 1, 693 ff; 1926, 2, 677 ff; 1927, 3, 689 ff. 4. Black, G. V. Operative Dentistry, Chicago, Medico-Dental Publishing Co., 1920. 5. Buffalo, University of. Catalogue of the School of Dentistry, Februarv, 1929. 6. Dental Education in the United States and Canada, Bulletin No. 19, 1926. The Carnegie Foundation for the Advancement of Teaching. 7. Columbia University. Bulletin of Information, School of Dental and Oral Surgery, Sept. 1929. 8. Cunliffe, E. B. Whither Away and Why! Trends in Choice of Vocation in Detroit. Person. J., 1927, 6, 25-28. 9. Davies, O. V. A Method of Applying Industrial Psychology to Dentistry. ?New Zealand Dental Journal, 1925, 20, 15?16. 10. Dental Faculties Association of American Universities. Minutes and Proceedings, 1908-1924, p. 113. 11. Hannum, J. E. Eye Strain in Various Occupations. Industrial Psychology, 1926, 1, 529-534. 12. Jones, E. S. A Summary of Replies to Questions on the Various Occupations. Buffalo University Studies, Vol. 4, No. 4, 1926. 182 THE PSYCHOLOGICAL CLINIC 13. Marbe, K. Die Eignung zur Zahnheilkunde und ihre psychotechnische Priifung. Deutsche Zahnartzliche Wochenschrift, 1928, 31, 233-240. 14. Marbe, K. Die Eignung fiir die Chirurgie, Orthopadie und Zahnheilkunde. Deutsche Zeitschrift fiir Chirurgie, 1928, 208, 289-317. 15. Michigan, University of. Vocational Information. A Bibliography, Yoc. Series, No. 1, 1928. 16. Payne, A. F. Organization of Vocational Guidance, 1925, p. 307. 17. Quinby, H. C. Finger Training in Dentistry. Address before Midland Branch of the British Dental Assoc., Liverpool, May 17, 1889. Liverpool, Walinsley, 1889. 18. Roe, A. M., and Brown, C. F. Qualifications for Dentistry: A Preliminary Study. Person. J., 1927, 6, 176?181. 19. Schorn, M. Untersuchungen iiber die Handgeschicklichkeit. Zscli. f. Psychol., 1929, 112, 325-378. 20. Taylor, James A. History of Dentistry. Philadelphia, Lea, 1922. 21. Schultz, R. S. The Relation of Maze Adaptability, Maze Learning, and General Intelligence. Amer. J. Psychol., 1932, 44, 249-262. 22. Toronto, University of. Calendar of the Faculty of Dentistry, 1929-30. 23. Toronto, University of. Faculty of Dentistry, Course in Dental Technology. Form Tech. 1, 1926. 24. Whipple, G. M. Diagnosing Operative Skill in Dentistry. Person. J., 7, 1928, p. 150.
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