Level of Satisfaction of Post-Doctoral Graduates with the Instruction of Clinical Skills: A Cross-Sectional Self-Assessment Study in 2019 and 2020

Level of Satisfaction of Post-Doctoral Graduates with the Instruction of Clinical Skills: A Cross-Sectional Self-Assessment Study in 2019 and 2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Level of Satisfaction of Post-Doctoral Graduates with the Instruction of Clinical Skills: A Cross-Sectional Self-Assessment Study in 2019 and 2020 Behzad Houshmand, Nushin Salehi, Maryam Safarnavadeh, Abolfazl Azimi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6264122/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background Iranian dental residency programs' clinical skills training satisfaction assessment is crucial in determining graduates' professional competency at the global scale. This study evaluated Iranian dental residency graduates' satisfaction with clinical skills training, addressing a gap in national-level data. Methods In this cross-sectional, analytical, descriptive study, 500 graduates of seven dental residency programs who took the 2019 and 2020 Iranian national board dental examination were studied. Online pre-examination testing used a validated, reliable researcher-made questionnaire (content validity ratio = 0.8, Cronbach's α = 0.92) for satisfaction with clinical skills instruction. Participants provided informed consent via an online opt-in form. Data were subjected to Mann-Whitney and Kruskal-Wallis tests in SPSS version 21 (α = 0.05) for comparing satisfaction based on work experience and type of university. Results Response rate was 92.6% (n = 463). Range of mean satisfaction with clinical skills was 60% (oral and maxillofacial surgery) to 79.5% (periodontics). Type 1 university graduates were significantly more satisfied than type 2 graduates (P < 0.001), but there were no significant differences between specialties (P = 0.053). Satisfaction below 50% was unusual but was notable in oral surgery. Conclusions Satisfaction exceeded 50% across all specialties but was low in oral and maxillofacial surgery (60%) when these complex fields were most in need of it. Internationally, these findings highlight the imperative of matching the clinical curriculum to professional requirements. Residency programs are encouraged to focus more on enhanced clinical exposure and inter-disciplinary training to boost competency, serving as a model for international curriculum change. Clinical Skills Dental Education Residency Programs Satisfaction Curriculum Reform Figures Figure 1 Figure 2 Introduction Assessment and confirmation of clinical proficiency of residents is among the most important, yet difficult, responsibilities of the faculty members and instructors of the healthcare system [ 1 ]. Training of human resources in the field of medical sciences is imperative for the physical and mental health of the general population in any society. Medical graduates suggest some clinical strategies for health promotion of the community based on requirements of the society and weaknesses and flaws of the healthcare system [ 2 ]. Achieving this goal requires training of residents with high level of scientific and clinical proficiency in different medical fields [ 2 ]. Thus, assessing the educational quality and clinical proficiency of residents is of utmost importance. Also, it is imperative to adopt efficient educational methods, create a suitable environment to thrive, provide the required materials and instruments, and design successful educational curricula and programs to achieve this goal [ 3 ]. Dentistry is a field of profession that requires knowledge, clinical skills, and clinical experience. Disease prevention, maintenance and promotion of oral health in the community, and training skillful human resources are the major goals of any healthcare system in the field of dentistry. Problems and shortcomings in dental educational curricula can compromise the objectives of residency programs and adversely affect the efficiency and proficiency of graduates [ 4 ]. In some dental specialty fields such as oral and maxillofacial surgery and periodontology, the main part of the learning process takes place during the residency period. Thus, assessment of the quality of instruction of clinical skills comprises the main part of the assessment [ 5 ]. Evaluation of post-graduate dental curricula to resolve the problems and improve their quality depends on a number of variables, such as the residents, clinical and theoretical instructors, the staff, and other parameters in the academic environment of dental schools that can directly or indirectly affect the learning process [ 4 , 5 ]. Assessment of the quality of learning and instruction, and their qualitative and quantitative appraisal for evaluation of the adequacy of educational curricula and their promotion are difficult tasks to accomplish [ 5 ]. One method to appraise and promote the educational activities is to focus on the target group, i.e. dental residents. While studies worldwide have explored student satisfaction with dental education, no national-level study in Iran has assessed graduates’ perspectives on clinical skills training [ 8 ]. This study aimed to evaluate Iranian dental residency graduates’ satisfaction with clinical skills instruction in 2019 and 2020, providing baseline data for curriculum improvement locally and insights applicable to global dental education. Aim, Need, and Necessity of Research The main research question of this study is to assess the level of satisfaction of post-doctoral dental graduates regarding the teaching of clinical skills in 2019 and 2020 after their board exams. This evaluation is important for several reasons. Understanding Essential Needs In the first place, this research aims at identifying educational requirements of dental graduates in relation to our particular educational program. Thus, the assessment of post-doctoral graduates’ satisfaction levels will help reveal key areas for improvement in educational provisions. Appreciation of these needs is crucial for enhancing the relevance and quality of our educational programs, so as to prepare graduates for their professional practice in the best way possible. Enhancing Professional Competence Furthermore, it is the aim of this study to enhance the professional development of skills in the dental specialty. In order to achieve this, we aim to analyze the graduates’ satisfaction levels in the hope of identifying where additional skills may be useful. This may provide a basis for specific changes in the clinical education of the future dentists and other dental workers, which, in turn, may help improve the quality of patient care. Unprecedented Examination in Iran Of particular interest is the fact that, to the best of our knowledge, no similar comprehensive evaluation of satisfaction regarding the training of clinical skills among dental graduates has been conducted in Iran before. In this regard, this study seeks to explore new frontiers in the hope of satisfying a significant research niche. It aims at providing information which can be useful not only to our local educational institutions but also to similar programmes in other parts of the world. With these objectives in mind, this research aims at bringing out the current situation with regards to post-doctoral dental education with an aim at highlighting the areas of excellence as well as areas that may require enhancement. Materials and Methods The study population comprised of 500 participants of the Iranian national board dental examination in 2019 and 2020. After coordination with the Iranian Professional Council, questionnaires were hosted on the examination website, targeting all registered participants exhaustively without sampling. The validity of the questionnaires was confirmed by content validity tests (content validity ratio = 0.8, and content validity index = 0.8), and their reliability were confirmed by the Cronbach’s alpha (α = 0.92). Researcher-designed questionnaires were developed by the instructing and consulting professors, and a dental student, and their validity and reliability were evaluated according to the opinions of 10 experts (full professors, and associate professors of periodontics, oral and maxillofacial surgery, removable and fixed prosthodontics, endodontics, restorative dentistry, orthodontics, and pedodontics) by calculating content validity and the Cronbach’s alpha. The questionnaire was developed specifically for this study and has not been published elsewhere. A different questionnaire was designed for each of the seven dental specialty programs (Periodontics, Oral and Maxillofacial Surgery, Removable and Fixed Prosthodontics, Endodontics, Restorative Dentistry, Orthodontics, and Pedodontics) according to their approved curricula. The English-language versions of these questionnaires are respectively merged and provided as a Supplementary File 1. The questionnaires had 2 parts. The first part evaluated the level of satisfaction of graduates with the quality of instruction of clinical skills, which included 7 questions. They were also questioned about their educational needs regarding particular skills after graduation. The second part was designed to assess the efficacy of instructions provided during each residency program to acquire professional skills and clinical proficiency. This part was designed differently for each of the 7 dental specialty programs. Participants also reported their university type and years of work experience. Participant Selection The entry criteria for participant selection encompassed individuals who were concurrently preparing for the board examination and met the specified conditions required for participation in the exam. Since the target group was enrolled from the outset of the study, no specific exit criteria were employed. Prior to participation, all individuals were provided with a clear explanation of the study’s objectives and the nature of their involvement. By choosing to complete the questionnaire, participants implicitly indicated their consent to be included in the study. Additionally, they were informed about the voluntary nature of their involvement and were assured of the confidentiality and anonymity of their responses. Participants consisted of individuals within the dental education community who voluntarily completed the questionnaire, contributing to the cross-sectional snapshot of perspectives within the field. After coordination with the Professional Council, the questionnaires were uploaded in the website of national board dental examination in 2019 and 2020, and all participants were requested to fill out the questionnaires. In the instructions given to the participants regarding the questionnaire, they were ensured about the confidentiality of their information and anonymous assessment of questionnaires. To specify data collection, all counting was performed in an exhaustive manner, encompassing the entire population of interest. The study purposively aimed to include all available individuals or entities within the defined parameters, thereby leading to a comprehensive examination without employing traditional sampling methods. Ethical Considerations Participants received a clear explanation of the study’s objectives and provided informed consent via an online opt-in form, with ethical approval ethics committee of School of Dentistry, Shahid Beheshti University of Medical Sciences (ethical approval code: IR.SBMU.DRC.REC.1399.141). They were assured of voluntary participation, confidentiality, and anonymity of responses. Defining University Types To categorize Iranian dental education institutions for this cross-sectional study, we developed a typology based on their research orientation, resources, faculty expertise, and program offerings. The following classifications were used to distinguish universities by their educational focus and infrastructure: Type 1 University Type 1 universities are research-oriented universities which may contain comprehensive dental research facilities and are highly committed to the progress of dental knowledge and dental technology. Such universities usually have numerous postgraduate and research-oriented courses in dental education. Type 2 University Type 2 schools include universities that aim at offering a blend between research and practice in dental studies. These universities offer various undergraduate and postgraduate dental programs including clinical teaching with practical experience. Type 3 University Type 3 universities are mainly clinical teaching institutions, stressing practice and community health care in dentistry. These institutions may not focus much on research programs and instead focus on training students for direct patient care and community service. The Mann-Whitney and Kruskal-Wallis tests were used to compare the responses about the ordinal variables at 0. 05 level of significance, with P < 0.001 reported for key comparisons (e.g., university type differences). The Mann-Whitney test was employed to determine the relationship between level of satisfaction of graduates with their work experience in dentistry while the Kruskal-Wallis test was employed to determine the relationship between level of satisfaction of participants with the type of university attended. All statistical analysis used in this study were done using the Statistical Package for Social Science (SPSS) version 21. Results This study was conducted on 500 participants of the national board dental examination in 2019 and 2020; out of which, 463 returned the questionnaires, yielding a response rate of 92.6%. Of the participants, 280 participated in the national board dental examination in 2019, and 183 participated in the national board dental examination in 2020. Of all participants, 58 (10.5%) were restorative dentistry graduates, 61 (11.1%) were pedodontics graduates, 67 (12.1%) were orthodontics graduates, 61 (11.1%) were periodontics graduates, 75 (13.6%) were endodontics graduates, 68 (12.3%) were prosthodontics graduates, and 73 (13.2%) were oral and maxillofacial surgery graduates. Regarding the type of university, 285 (61.5%) had been graduated from type 1 universities, 129 (27.9%) had been graduated from type 2 universities, 47 (10.2%) had been graduated from different branches of Islamic Azad University, and 2 (0.4%) had been graduated from foreign universities. Regarding dental work experience, 179 participants responded to this question; out of which, 106 (59.2%) had ≤ 3 years of work experience, and 73 (40.8%) had a work experience > 3 years. The frequency distribution of responses regarding level of satisfaction of participants with the set objectives regarding professional skills and their educational needs was reported by descriptive statistics (number and percentage) separately for each of the 7 specialties. In overall assessment of each specialty field, the mean percentage of excellent and good satisfaction levels was 58.5% for oral and maxillofacial surgery, 59.1% for orthodontics, 62.2% for prosthodontics, 71.2% for endodontics, 72.6% for restorative dentistry, 73% for pedodontics, and 77.5% for periodontics (Fig. 1 ). The mean percentage of excellent and good satisfaction levels with the acquired clinical skills during the residency period was 60% for oral and maxillofacial surgery, 62.5% for orthodontics, 71.2% for prosthodontics, 73.1% for endodontics, 73.4% for pedodontics, 75.2% for restorative dentistry, and 79.5% for periodontics (Fig. 2 ). To compare the level of satisfaction of graduates with different fields of residency, the mean satisfaction level with each residency program was calculated according to the average responses. According to the Kruskal-Wallis test, in overall assessment of different specialty programs, level of satisfaction with oral and maxillofacial surgery residency program was lower than that for restorative dentistry (P = 0.029), pedodontics (P = 0.015), periodontics (P = 0.014), and oral and maxillofacial radiology (P = 0.008). Level of satisfaction with orthodontics residency program was lower than that for pedodontics (P = 0.031), periodontics (P = 0.028), and oral and maxillofacial radiology (P = 0.017). Also, level of satisfaction with prosthodontics residency program was lower than that for pedodontics (P = 0.028), periodontics (P = 0.026), and oral and maxillofacial radiology (P = 0.015). However, in comparison of the acquired clinical skills, the difference among different specialty programs was not significant (P = 0.053). The Kruskal-Wallis test was used to assess the level of satisfaction of graduates with the acquired clinical skills in different specialty programs based on the type of university (type 1, type 2, and Islamic Azad University). Foreign universities were excluded from this analysis. The results showed that in pedodontics specialty program, level of satisfaction with “dissertation” was higher among Islamic Azad University graduates than type 2 university graduates (P = 0.010). In orthodontics, level of satisfaction with “number of faculty members of the group” was higher among Islamic Azad University graduates than graduates from type 1 and type 2 universities (P = 0.000). Also, level of satisfaction with “overall assessment of the entire program” (P = 0.030) and “forensic medicine laws and regulations” (P = 0.001) was higher among Islamic Azad University graduates than graduates from type 2 universities. Level of satisfaction with “research method” was higher among Islamic Azad University graduates than graduates from type 2 universities (P = 0.025). Level of satisfaction with “proficiency of faculty members of the group” (P = 0.037), “clinical pharmacology” (P = 0.031), and “medical emergencies” (P = 0.028) among type 1 and type 2 university graduates was significantly higher than Islamic Azad University graduates. In oral and maxillofacial surgery, level of satisfaction with “quality of treated clinical cases” (P = 0.045), “number of treated clinical cases” (P = 0.013), “extraction of impacted teeth” (P = 0.035), “arch bar” (P = 0.002), “plate and screw” (P = 0.002), “mandibular fractures” (P = 0.020), “midface fractures” (P = 0.007), and “upper face fractures” (P = 0.007) was higher among type 1 university graduates than type 2 university graduates. In periodontics, level of satisfaction with “proficiency of faculty members of the group” (P = 0.001), and “soft tissue grafting” (P = 0.031) was significantly different among types 1 and 2 university graduates. Level of satisfaction with “overall assessment of the program” (P = 0.029) and “root coverage” (P = 0.009) was higher among types 1 and 2 university graduates compared with Islamic Azad University graduates. Level of satisfaction with “patient follow-up” (P = 0.040) was higher in type 1 university graduates compared with Islamic Azad University graduates. In endodontics, level of satisfaction with “quality of basic science courses” (P = 0.038) was higher among type 1 university graduates than type 2 university graduates. In restorative dentistry, level of satisfaction with “assessment of published articles” (P = 0.035) was higher among type 2 university graduates than Islamic Azad University graduates. The Mann-Whitney test was used to assess the overall level of satisfaction with the acquired clinical skills in different specialty programs based on dental work history of participants (≤ 3 and > 3 years). The results showed that in periodontics program, level of satisfaction of the second group (> 3 years of experience) was significantly higher with “quality of interdepartmental courses” (P = 0.025), “proficiency of faculty members of the group” (P = 0.025), “number of faculty members of the group” (P = 0.038), “overall assessment of the program” (P = 0.027), “education of students” (P = 0.027), “assessment of published articles” (P = 0.014), “periodontal flap” (P = 0.035), “gingivectomy” (P = 0.006), “impacted tooth exposure” (P = 0.041), and “horizontal augmentation” (P = 0.049), compared with the first group (≤ 3 years of experience). Also, in pedodontics, the second group gave a higher score to “tooth restoration” (P = 0.037) than the first group. Discussion The goal of global healthcare systems and dental educational curricula is to train graduates with high level of knowledge and proficiency to promote the community oral health. Accordingly, devising an efficient assessment system to improve the quality of theoretical and clinical instruction is imperative to achieve this goal. Assessment of the satisfaction level of graduates of specialty programs with the acquired skills is one method for quality assessment of dental educational curricula for clinical specialties. Thus, this study assessed the level of satisfaction of graduates with the acquired skills during their residency program. The present study did not find a significant difference among different specialty programs in this regard. However, the mean satisfaction level of graduates (with the overall program and the acquired clinical skills) was the lowest in oral and maxillofacial surgery, orthodontics, and prosthodontics and the highest in periodontics and restorative dentistry. In general, the level of satisfaction with all specialty programs was above the average (> 50%). Eslamipour et al. [ 6 ] reported a significant difference in level of satisfaction of dental students with different departments; the students had the highest satisfaction level (in all items) with periodontics and orthodontics departments and the lowest level of satisfaction with endodontics and prosthodontics departments. Despite the differences, the mean level of satisfaction of students with all departments was favorable [ 6 ]. Their results were in line with the present findings. Satisfaction indicates optimal quality of education in all domains, theoretically and clinically [ 8 ]. Acquiring clinical skills is a key step in healthcare education. Lower satisfaction level of graduates with oral and maxillofacial surgery residency program may be due to extensiveness and diversity of professional topics beyond the basic dental instructions, teaching of clinical skills in a hospital setting, which is significantly different from the university setting, and difficult and heavy workload, which can all adversely affect the level of satisfaction [ 7 ]. Diversity of the taught topics and high workload are also present in prosthodontics and endodontics specialty programs [ 7 ]. Amini et al. [ 7 ] discussed that lower level of satisfaction with some clinical fields may be attributed to complexity of the learning process and acquiring the skills, inadequate exposure to clinical scenarios, insufficient practice, and not including the taught skills in daily tasks of undergraduate/postgraduate students. This was also true for the Endodontics Department of School of Dentistry of Tabriz University of Medical Sciences. Although the results of Amini et al. [ 7 ] were different from the present findings, the abovementioned reasons may also be applicable to the present study and justify the low satisfaction level of graduates with some items. Fontana et al. [ 8 ] suggested that the educational curricula should also include basic science, clinical skills, critical thinking skills for lifelong learning, ethical and professional values, and management skills in order to be able to meet the future needs of graduates and gain their satisfaction. The reported weaknesses of educational programs from the perspective of graduates in almost all professional skills indicate the need for revision of the educational curricula to improve and update the quality of instruction. Zamanzad et al. [ 9 ] showed that the main concern of medical students during their internship and externship programs was that they required the instructors to mainly focus on their future needs as a general practitioner. This can be applied to all clinical medical and dental specialty programs as well, and calls for further attention of the authorities to improve the quality of clinical training. Lack of a significant correlation between the grade point average of residents and their satisfaction level in a study by Amanat et al. [ 10 ] may be related to discoordination between the educational topics and goals and their method of assessment in different departments. Considering the fact that interdepartmental topics and basic sciences require further coordination and involvement of several instructors, their programming and quality control are more difficult. This is particularly important for interdepartmental and multidisciplinary topics involving orthodontics, prosthodontics, and oral and maxillofacial surgery. In the present study, graduates of periodontics program had the highest level of satisfaction with “infection control”, “clinical pharmacology”, and “medical emergencies”, which appears to be partly due to the fact that this program has gained a more integrated structure as the result of diversity of related sciences in the field of periodontics and having a longer history [ 8 ]. Also, the level of satisfaction of graduates with > 3 years of work experience was generally higher, particularly in the periodontics program, which may be due to the fact that those with a longer work experience could better perceive and comprehend the actual clinical educational needs in the clinical setting. In total, dental work experience can definitely affect the level of satisfaction with the acquired clinical skills. This aligns with Zamanzad et al. [ 9 ], who found medical trainees value future-focused instruction, a principle extendable to dental residency worldwide. Type of university had the greatest effect on level of satisfaction of graduates from oral and maxillofacial surgery, orthodontics, and periodontics residency programs. This finding may be partly due to the extensiveness of the taught topics and the need for stronger interdisciplinary and interdepartmental communications in these fields. This finding highlights the need for revision of educational curricula and balancing the software and hardware facilities in types 1 and 2 universities and Islamic Azad University. The growing knowledge and novel equipment underline the need for frequent revisions of clinical educational curricula [ 11 ]. For instance, it appears that the required number of clinical requirements in the curricula needs to be revised. High number of requests for instruction of micro-endodontics in the endodontics program, supplemental education regarding overdenture and cosmetic procedures in prosthodontics program, fabrication of implant prosthesis in restorative dentistry program, and so on, highlights the need for inclusion of these topics in the logbook of postgraduate students. Also, timing of offering the clinical courses and scientific communication between residents and instructors play fundamental roles in quality of clinical training and satisfaction level of graduates. Consistent with this statement, Amanat et al. [ 10 ] discussed that lower level of satisfaction of students with some departments such as Oral and Maxillofacial Surgery Department of School of Dentistry of Shiraz University of Medical Sciences was attributed to inadequate time allocated to scientific communication of students and mentors in the academic environment. The personal opinion of the participants was evaluated in this study. The level of achievement of educational goals regarding clinical skills cannot be evaluated without testing the clinical proficiency of graduates [ 12 ]. Risk of bias always exists in studies that are based on personal opinion of the participants, and expectations from themselves and the educational system, interpersonal differences, psychological status of the participants, and their socioeconomic concerns can all affect the results. Brown et al. [ 13 ] demonstrated that one strategy to increase the efficacy of self-assessment questionnaires is to use a ranking system instead of quantitative variables. Thus, we used a ranking system in the present study to compare the opinion of the participants. However, Mays and Branch-Mays [ 12 ] in a systematic review discussed that graduates should be able to self-assess their capabilities but it is not clear whether this self-assessment can practically yield favorable results. Thus, they suggested an examination to test the clinical skills of graduates to more accurately assess the level of achievement of clinical educational goals [ 12 ]. In fact, the present study was a pilot study to pave the way for future investigations. Thus, further studies are required to obtain more accurate results in this respect. The present study was conducted on graduates who had passed all the required courses, and were ready to start their practice outside the university setting, and their level of satisfaction with the learned clinical skills was evaluated by designing questionnaires according to the respective educational curricula. Sun et al. [ 14 ] stated that the perception of transferable skills of dental and oral health students can be assessed by designing self-assessment scales before and after their graduation, and design educational and clinical programs according to ethical standards. This study can serve as a reliable tool for dental faculty members to assess the perception of students from theoretical and clinical skills. Moreover, the scientific and clinical skills evaluated in this study can play a pivotal role in improving the educational curricula such that the students acquire the required proficiency after successfully completing the program. As a pioneering national study in Iran, it provides a baseline for international comparison, despite lacking direct equivalents to compare with. Other limitations of this study include difficulty in concentration due to stressful condition of the board examination, and inadequate exposure to clinical scenarios due to not having adequate work experience outside the university setting. Moreover, the present data were obtained from the participants of the national board dental examination, and do not necessarily reflect the opinion of all general dentists and specialists. In other words, the present study was a preliminary study to pave the way for further investigations in this regard. Thus, future studies are required to obtain more accurate results. Conclusion Graduate satisfaction with clinical skills training exceeded 50% in all specialties, ranging from 60.0% (oral and maxillofacial surgery) to 79.5% (periodontics), with graduates from Type 1 universities being more satisfied than those from Type 2 (P < 0.001). Poor oral and maxillofacial surgery scores reflect the need for more clinical exposure in specialized areas. A model for the assessment of clinical training satisfaction is presented in this article, which can be extrapolated to dental education worldwide. Further curriculum reform should emphasize interdisciplinary education and equality of resources to improve professional competency, with a model that can be used worldwide in dental education. Abbreviations CVR: Content Validity Ratio; CVI: Content Validity Index; Fig.: Figure; P: P-value; SBMU: Shahid Beheshti University of Medical Sciences; α: Cronbach’s Alpha; SPSS: Statistical Package for the Social Sciences Declarations Ethics Approval and Consent to Participate This study was approved by the ethics committee of the School of Dentistry, Shahid Beheshti University of Medical Sciences (ethical approval code: IR.SBMU.DRC.REC.1399.141). Participants provided informed consent via an online opt-in form prior to completing the questionnaire. They were informed of the voluntary nature of participation, confidentiality, and anonymity of their responses. Consent for Publication Not applicable, as no individual participant data are included in this manuscript. Availability of Data and Materials The questionnaires used in this study are available as Supplementary File 1. Additional data are available from the corresponding author, Abolfazl Azimi, upon reasonable request. Due to privacy and ethical restrictions, participant data cannot be made publicly available. Competing Interests The authors declare no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ Contributions BH contributed to conceptualization, methodology, and supervision. NS conducted data collection, analysis, and wrote the original draft. MS contributed to writing, review, and editing, and supervision. AA handled data curation, project administration, writing, review, and editing, and served as the corresponding author. PF contributed to data collection. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the executive members and personnel of the Dental Education Council of the Iranian Ministry of Health and Medical Education for their help in distributing and collecting questionnaires. We also extend our appreciation to the Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran, for providing important resources and support. Additionally, we express our gratitude to the participants of the Iranian national board dental examination for their cooperation. References Elangovan S, Venugopalan SR, Srinivasan S, Karimbux NY, Weistroffer P, Allareddy V. (2016). Integration of basic-clinical sciences, PBL, CBL, and IPE in U.S. dental schools’ curricula and a proposed integrated curriculum model for the future. *Journal Dent Educ 80*(3), 281–90. Chan WP, Wu TY, Hsieh MS, et al. Students’ view upon graduation: A survey of medical education in Taiwan. *BMC Med Educ. 2012;12(1):127–34. Bassir SH, Sadr-Eshkevari P, Amirikhorheh S, Karimbux NY. (2014). Problem-based learning in dental education: A systematic review of the literature. *Journal Dent Educ 78*(1), 98–109. Wardman MJ, Yorke VC, Hallam JL. (2017). 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Supplementary Files SupplementaryFile1questionnaire.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 11 Jun, 2025 Reviews received at journal 09 Jun, 2025 Reviews received at journal 08 Jun, 2025 Reviews received at journal 03 Jun, 2025 Reviewers agreed at journal 22 May, 2025 Reviews received at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 18 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviewers invited by journal 16 May, 2025 Editor assigned by journal 29 Apr, 2025 Submission checks completed at journal 28 Apr, 2025 First submitted to journal 28 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6264122","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449209231,"identity":"ba21e3a4-893c-4e98-8851-9ff6a44a28a2","order_by":0,"name":"Behzad Houshmand","email":"","orcid":"","institution":"Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical science, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Behzad","middleName":"","lastName":"Houshmand","suffix":""},{"id":449209233,"identity":"da0bf63e-d976-422c-9d07-5d73773d60c8","order_by":1,"name":"Nushin Salehi","email":"","orcid":"","institution":"Department of Periodontics, School of Dentistry, Qazvin University of Medical Sciences, Qazvin","correspondingAuthor":false,"prefix":"","firstName":"Nushin","middleName":"","lastName":"Salehi","suffix":""},{"id":449209234,"identity":"f8479d1b-b93f-44ff-9641-17e3176258a8","order_by":2,"name":"Maryam Safarnavadeh","email":"","orcid":"","institution":"Ministry of Health and Medical Education","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Safarnavadeh","suffix":""},{"id":449209237,"identity":"e3e29d29-b812-4458-bdc5-c49533c9d268","order_by":3,"name":"Abolfazl Azimi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie3QMUsDMRQH8JTC61LsWikkn0DIceAk9Vs4vyD0lhYElxsc0qE3+gVu8Cu0CM4pgbocdFXscCJ0ziRO4suhmxd0E8x/SXi8Xx4vjMXE/MEA62iGzLCDrmGszofcV00dIIMvAoCMYXWSNgQD5FA3xydRxUQ1hRCRW7tY1lc7DtB9cVjZ7ObMPtOUMT/SLcSsiwfc7FMAkBJzO1s9TSSR8/TYtJD1nAhYVQgtkabMViV6YtRdCzm1HSLvRKDnjCpslpSZCxK5IUKdRPqJpvVRjKbhKbLy5Nrv0r/0n5wsR9MLgzKwy/Z+//j2uuMD6N06lw+FKDN/GfM28s0jTaf8abuP0L/pjomJifkP+QD0D26ywFjAMwAAAABJRU5ErkJggg==","orcid":"","institution":"Islamic Azad University Dental Branch of Tehran","correspondingAuthor":true,"prefix":"","firstName":"Abolfazl","middleName":"","lastName":"Azimi","suffix":""},{"id":449209239,"identity":"b5e2def2-cb64-45ba-bba2-f7f2a31a9d9d","order_by":4,"name":"Parham Fathizadeh","email":"","orcid":"","institution":"Department of Periodontics, Faculty of Dentistry, Tehran Medical Sciences Islamic Azad University, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Parham","middleName":"","lastName":"Fathizadeh","suffix":""}],"badges":[],"createdAt":"2025-03-19 19:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6264122/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6264122/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81966699,"identity":"87e70e7b-fb5c-4a21-89a0-e55214d581c8","added_by":"auto","created_at":"2025-05-05 11:37:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36233,"visible":true,"origin":"","legend":"\u003cp\u003eOverall level of satisfaction (%) of participants with different dental specialty programs in 2019 and 2020\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6264122/v1/e1c379f2ce538567a00f7c34.png"},{"id":81968728,"identity":"73ea47c6-54c8-4a4c-95e5-8a100e246a57","added_by":"auto","created_at":"2025-05-05 11:53:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33860,"visible":true,"origin":"","legend":"\u003cp\u003eOverall level of satisfaction of participants (%) with the acquired clinical skills in each dental residency program in 2019 and 2020\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6264122/v1/cdc63bdc94d8fd9d03c7967d.png"},{"id":81968748,"identity":"b6c262ea-6ea9-4139-85ce-ad8b740553b8","added_by":"auto","created_at":"2025-05-05 11:53:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":613199,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6264122/v1/b08b43fc-fb9b-4d02-90b2-fd74dc8d2fa5.pdf"},{"id":81967949,"identity":"e9220de7-920f-4549-a145-25b93c10e64a","added_by":"auto","created_at":"2025-05-05 11:45:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":486710,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1questionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6264122/v1/3bfc7e2e18285efe5fada4ec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Level of Satisfaction of Post-Doctoral Graduates with the Instruction of Clinical Skills: A Cross-Sectional Self-Assessment Study in 2019 and 2020","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAssessment and confirmation of clinical proficiency of residents is among the most important, yet difficult, responsibilities of the faculty members and instructors of the healthcare system [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Training of human resources in the field of medical sciences is imperative for the physical and mental health of the general population in any society. Medical graduates suggest some clinical strategies for health promotion of the community based on requirements of the society and weaknesses and flaws of the healthcare system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Achieving this goal requires training of residents with high level of scientific and clinical proficiency in different medical fields [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Thus, assessing the educational quality and clinical proficiency of residents is of utmost importance. Also, it is imperative to adopt efficient educational methods, create a suitable environment to thrive, provide the required materials and instruments, and design successful educational curricula and programs to achieve this goal [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDentistry is a field of profession that requires knowledge, clinical skills, and clinical experience. Disease prevention, maintenance and promotion of oral health in the community, and training skillful human resources are the major goals of any healthcare system in the field of dentistry. Problems and shortcomings in dental educational curricula can compromise the objectives of residency programs and adversely affect the efficiency and proficiency of graduates [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In some dental specialty fields such as oral and maxillofacial surgery and periodontology, the main part of the learning process takes place during the residency period. Thus, assessment of the quality of instruction of clinical skills comprises the main part of the assessment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Evaluation of post-graduate dental curricula to resolve the problems and improve their quality depends on a number of variables, such as the residents, clinical and theoretical instructors, the staff, and other parameters in the academic environment of dental schools that can directly or indirectly affect the learning process [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Assessment of the quality of learning and instruction, and their qualitative and quantitative appraisal for evaluation of the adequacy of educational curricula and their promotion are difficult tasks to accomplish [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. One method to appraise and promote the educational activities is to focus on the target group, i.e. dental residents. While studies worldwide have explored student satisfaction with dental education, no national-level study in Iran has assessed graduates\u0026rsquo; perspectives on clinical skills training [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study aimed to evaluate Iranian dental residency graduates\u0026rsquo; satisfaction with clinical skills instruction in 2019 and 2020, providing baseline data for curriculum improvement locally and insights applicable to global dental education.\u003c/p\u003e\n\u003ch3\u003eAim, Need, and Necessity of Research\u003c/h3\u003e\n\u003cp\u003eThe main research question of this study is to assess the level of satisfaction of post-doctoral dental graduates regarding the teaching of clinical skills in 2019 and 2020 after their board exams. This evaluation is important for several reasons.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eUnderstanding Essential Needs\u003c/h2\u003e \u003cp\u003eIn the first place, this research aims at identifying educational requirements of dental graduates in relation to our particular educational program. Thus, the assessment of post-doctoral graduates\u0026rsquo; satisfaction levels will help reveal key areas for improvement in educational provisions. Appreciation of these needs is crucial for enhancing the relevance and quality of our educational programs, so as to prepare graduates for their professional practice in the best way possible.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEnhancing Professional Competence\u003c/h3\u003e\n\u003cp\u003eFurthermore, it is the aim of this study to enhance the professional development of skills in the dental specialty. In order to achieve this, we aim to analyze the graduates\u0026rsquo; satisfaction levels in the hope of identifying where additional skills may be useful. This may provide a basis for specific changes in the clinical education of the future dentists and other dental workers, which, in turn, may help improve the quality of patient care.\u003c/p\u003e\n\u003ch3\u003eUnprecedented Examination in Iran\u003c/h3\u003e\n\u003cp\u003eOf particular interest is the fact that, to the best of our knowledge, no similar comprehensive evaluation of satisfaction regarding the training of clinical skills among dental graduates has been conducted in Iran before. In this regard, this study seeks to explore new frontiers in the hope of satisfying a significant research niche. It aims at providing information which can be useful not only to our local educational institutions but also to similar programmes in other parts of the world. With these objectives in mind, this research aims at bringing out the current situation with regards to post-doctoral dental education with an aim at highlighting the areas of excellence as well as areas that may require enhancement.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe study population comprised of 500 participants of the Iranian national board dental examination in 2019 and 2020. After coordination with the Iranian Professional Council, questionnaires were hosted on the examination website, targeting all registered participants exhaustively without sampling. The validity of the questionnaires was confirmed by content validity tests (content validity ratio\u0026thinsp;=\u0026thinsp;0.8, and content validity index\u0026thinsp;=\u0026thinsp;0.8), and their reliability were confirmed by the Cronbach\u0026rsquo;s alpha (α\u0026thinsp;=\u0026thinsp;0.92). Researcher-designed questionnaires were developed by the instructing and consulting professors, and a dental student, and their validity and reliability were evaluated according to the opinions of 10 experts (full professors, and associate professors of periodontics, oral and maxillofacial surgery, removable and fixed prosthodontics, endodontics, restorative dentistry, orthodontics, and pedodontics) by calculating content validity and the Cronbach\u0026rsquo;s alpha. The questionnaire was developed specifically for this study and has not been published elsewhere. A different questionnaire was designed for each of the seven dental specialty programs (Periodontics, Oral and Maxillofacial Surgery, Removable and Fixed Prosthodontics, Endodontics, Restorative Dentistry, Orthodontics, and Pedodontics) according to their approved curricula. The English-language versions of these questionnaires are respectively merged and provided as a Supplementary File 1. The questionnaires had 2 parts. The first part evaluated the level of satisfaction of graduates with the quality of instruction of clinical skills, which included 7 questions. They were also questioned about their educational needs regarding particular skills after graduation. The second part was designed to assess the efficacy of instructions provided during each residency program to acquire professional skills and clinical proficiency. This part was designed differently for each of the 7 dental specialty programs. Participants also reported their university type and years of work experience.\u003c/p\u003e\n\u003ch3\u003eParticipant Selection\u003c/h3\u003e\n\u003cp\u003eThe entry criteria for participant selection encompassed individuals who were concurrently preparing for the board examination and met the specified conditions required for participation in the exam. Since the target group was enrolled from the outset of the study, no specific exit criteria were employed.\u003c/p\u003e \u003cp\u003ePrior to participation, all individuals were provided with a clear explanation of the study\u0026rsquo;s objectives and the nature of their involvement. By choosing to complete the questionnaire, participants implicitly indicated their consent to be included in the study. Additionally, they were informed about the voluntary nature of their involvement and were assured of the confidentiality and anonymity of their responses.\u003c/p\u003e \u003cp\u003eParticipants consisted of individuals within the dental education community who voluntarily completed the questionnaire, contributing to the cross-sectional snapshot of perspectives within the field. After coordination with the Professional Council, the questionnaires were uploaded in the website of national board dental examination in 2019 and 2020, and all participants were requested to fill out the questionnaires. In the instructions given to the participants regarding the questionnaire, they were ensured about the confidentiality of their information and anonymous assessment of questionnaires. To specify data collection, all counting was performed in an exhaustive manner, encompassing the entire population of interest. The study purposively aimed to include all available individuals or entities within the defined parameters, thereby leading to a comprehensive examination without employing traditional sampling methods.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e Participants received a clear explanation of the study\u0026rsquo;s objectives and provided informed consent via an online opt-in form, with ethical approval ethics committee of School of Dentistry, Shahid Beheshti University of Medical Sciences (ethical approval code: IR.SBMU.DRC.REC.1399.141). They were assured of voluntary participation, confidentiality, and anonymity of responses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefining University Types\u003c/h3\u003e\n\u003cp\u003eTo categorize Iranian dental education institutions for this cross-sectional study, we developed a typology based on their research orientation, resources, faculty expertise, and program offerings. The following classifications were used to distinguish universities by their educational focus and infrastructure:\u003c/p\u003e\n\u003ch3\u003eType 1 University\u003c/h3\u003e\n\u003cp\u003eType 1 universities are research-oriented universities which may contain comprehensive dental research facilities and are highly committed to the progress of dental knowledge and dental technology. Such universities usually have numerous postgraduate and research-oriented courses in dental education.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eType 2 University\u003c/h2\u003e \u003cp\u003eType 2 schools include universities that aim at offering a blend between research and practice in dental studies. These universities offer various undergraduate and postgraduate dental programs including clinical teaching with practical experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eType 3 University\u003c/h2\u003e \u003cp\u003eType 3 universities are mainly clinical teaching institutions, stressing practice and community health care in dentistry. These institutions may not focus much on research programs and instead focus on training students for direct patient care and community service.\u003c/p\u003e \u003cp\u003eThe Mann-Whitney and Kruskal-Wallis tests were used to compare the responses about the ordinal variables at 0. 05 level of significance, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 reported for key comparisons (e.g., university type differences). The Mann-Whitney test was employed to determine the relationship between level of satisfaction of graduates with their work experience in dentistry while the Kruskal-Wallis test was employed to determine the relationship between level of satisfaction of participants with the type of university attended. All statistical analysis used in this study were done using the Statistical Package for Social Science (SPSS) version 21.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study was conducted on 500 participants of the national board dental examination in 2019 and 2020; out of which, 463 returned the questionnaires, yielding a response rate of 92.6%. Of the participants, 280 participated in the national board dental examination in 2019, and 183 participated in the national board dental examination in 2020. Of all participants, 58 (10.5%) were restorative dentistry graduates, 61 (11.1%) were pedodontics graduates, 67 (12.1%) were orthodontics graduates, 61 (11.1%) were periodontics graduates, 75 (13.6%) were endodontics graduates, 68 (12.3%) were prosthodontics graduates, and 73 (13.2%) were oral and maxillofacial surgery graduates. Regarding the type of university, 285 (61.5%) had been graduated from type 1 universities, 129 (27.9%) had been graduated from type 2 universities, 47 (10.2%) had been graduated from different branches of Islamic Azad University, and 2 (0.4%) had been graduated from foreign universities. Regarding dental work experience, 179 participants responded to this question; out of which, 106 (59.2%) had\u0026thinsp;\u0026le;\u0026thinsp;3 years of work experience, and 73 (40.8%) had a work experience\u0026thinsp;\u0026gt;\u0026thinsp;3 years.\u003c/p\u003e \u003cp\u003eThe frequency distribution of responses regarding level of satisfaction of participants with the set objectives regarding professional skills and their educational needs was reported by descriptive statistics (number and percentage) separately for each of the 7 specialties. In overall assessment of each specialty field, the mean percentage of excellent and good satisfaction levels was 58.5% for oral and maxillofacial surgery, 59.1% for orthodontics, 62.2% for prosthodontics, 71.2% for endodontics, 72.6% for restorative dentistry, 73% for pedodontics, and 77.5% for periodontics (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean percentage of excellent and good satisfaction levels with the acquired clinical skills during the residency period was 60% for oral and maxillofacial surgery, 62.5% for orthodontics, 71.2% for prosthodontics, 73.1% for endodontics, 73.4% for pedodontics, 75.2% for restorative dentistry, and 79.5% for periodontics (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo compare the level of satisfaction of graduates with different fields of residency, the mean satisfaction level with each residency program was calculated according to the average responses. According to the Kruskal-Wallis test, in overall assessment of different specialty programs, level of satisfaction with oral and maxillofacial surgery residency program was lower than that for restorative dentistry (P\u0026thinsp;=\u0026thinsp;0.029), pedodontics (P\u0026thinsp;=\u0026thinsp;0.015), periodontics (P\u0026thinsp;=\u0026thinsp;0.014), and oral and maxillofacial radiology (P\u0026thinsp;=\u0026thinsp;0.008). Level of satisfaction with orthodontics residency program was lower than that for pedodontics (P\u0026thinsp;=\u0026thinsp;0.031), periodontics (P\u0026thinsp;=\u0026thinsp;0.028), and oral and maxillofacial radiology (P\u0026thinsp;=\u0026thinsp;0.017). Also, level of satisfaction with prosthodontics residency program was lower than that for pedodontics (P\u0026thinsp;=\u0026thinsp;0.028), periodontics (P\u0026thinsp;=\u0026thinsp;0.026), and oral and maxillofacial radiology (P\u0026thinsp;=\u0026thinsp;0.015). However, in comparison of the acquired clinical skills, the difference among different specialty programs was not significant (P\u0026thinsp;=\u0026thinsp;0.053).\u003c/p\u003e \u003cp\u003eThe Kruskal-Wallis test was used to assess the level of satisfaction of graduates with the acquired clinical skills in different specialty programs based on the type of university (type 1, type 2, and Islamic Azad University). Foreign universities were excluded from this analysis. The results showed that in pedodontics specialty program, level of satisfaction with \u0026ldquo;dissertation\u0026rdquo; was higher among Islamic Azad University graduates than type 2 university graduates (P\u0026thinsp;=\u0026thinsp;0.010).\u003c/p\u003e \u003cp\u003eIn orthodontics, level of satisfaction with \u0026ldquo;number of faculty members of the group\u0026rdquo; was higher among Islamic Azad University graduates than graduates from type 1 and type 2 universities (P\u0026thinsp;=\u0026thinsp;0.000). Also, level of satisfaction with \u0026ldquo;overall assessment of the entire program\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.030) and \u0026ldquo;forensic medicine laws and regulations\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.001) was higher among Islamic Azad University graduates than graduates from type 2 universities. Level of satisfaction with \u0026ldquo;research method\u0026rdquo; was higher among Islamic Azad University graduates than graduates from type 2 universities (P\u0026thinsp;=\u0026thinsp;0.025). Level of satisfaction with \u0026ldquo;proficiency of faculty members of the group\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.037), \u0026ldquo;clinical pharmacology\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.031), and \u0026ldquo;medical emergencies\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.028) among type 1 and type 2 university graduates was significantly higher than Islamic Azad University graduates.\u003c/p\u003e \u003cp\u003eIn oral and maxillofacial surgery, level of satisfaction with \u0026ldquo;quality of treated clinical cases\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.045), \u0026ldquo;number of treated clinical cases\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.013), \u0026ldquo;extraction of impacted teeth\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.035), \u0026ldquo;arch bar\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.002), \u0026ldquo;plate and screw\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.002), \u0026ldquo;mandibular fractures\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.020), \u0026ldquo;midface fractures\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.007), and \u0026ldquo;upper face fractures\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.007) was higher among type 1 university graduates than type 2 university graduates.\u003c/p\u003e \u003cp\u003eIn periodontics, level of satisfaction with \u0026ldquo;proficiency of faculty members of the group\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.001), and \u0026ldquo;soft tissue grafting\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.031) was significantly different among types 1 and 2 university graduates. Level of satisfaction with \u0026ldquo;overall assessment of the program\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.029) and \u0026ldquo;root coverage\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.009) was higher among types 1 and 2 university graduates compared with Islamic Azad University graduates. Level of satisfaction with \u0026ldquo;patient follow-up\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.040) was higher in type 1 university graduates compared with Islamic Azad University graduates.\u003c/p\u003e \u003cp\u003eIn endodontics, level of satisfaction with \u0026ldquo;quality of basic science courses\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.038) was higher among type 1 university graduates than type 2 university graduates.\u003c/p\u003e \u003cp\u003eIn restorative dentistry, level of satisfaction with \u0026ldquo;assessment of published articles\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.035) was higher among type 2 university graduates than Islamic Azad University graduates.\u003c/p\u003e \u003cp\u003eThe Mann-Whitney test was used to assess the overall level of satisfaction with the acquired clinical skills in different specialty programs based on dental work history of participants (\u0026le;\u0026thinsp;3 and \u0026gt;\u0026thinsp;3 years). The results showed that in periodontics program, level of satisfaction of the second group (\u0026gt;\u0026thinsp;3 years of experience) was significantly higher with \u0026ldquo;quality of interdepartmental courses\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.025), \u0026ldquo;proficiency of faculty members of the group\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.025), \u0026ldquo;number of faculty members of the group\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.038), \u0026ldquo;overall assessment of the program\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.027), \u0026ldquo;education of students\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.027), \u0026ldquo;assessment of published articles\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.014), \u0026ldquo;periodontal flap\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.035), \u0026ldquo;gingivectomy\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.006), \u0026ldquo;impacted tooth exposure\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.041), and \u0026ldquo;horizontal augmentation\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.049), compared with the first group (\u0026le;\u0026thinsp;3 years of experience). Also, in pedodontics, the second group gave a higher score to \u0026ldquo;tooth restoration\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.037) than the first group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe goal of global healthcare systems and dental educational curricula is to train graduates with high level of knowledge and proficiency to promote the community oral health. Accordingly, devising an efficient assessment system to improve the quality of theoretical and clinical instruction is imperative to achieve this goal. Assessment of the satisfaction level of graduates of specialty programs with the acquired skills is one method for quality assessment of dental educational curricula for clinical specialties. Thus, this study assessed the level of satisfaction of graduates with the acquired skills during their residency program.\u003c/p\u003e \u003cp\u003eThe present study did not find a significant difference among different specialty programs in this regard. However, the mean satisfaction level of graduates (with the overall program and the acquired clinical skills) was the lowest in oral and maxillofacial surgery, orthodontics, and prosthodontics and the highest in periodontics and restorative dentistry. In general, the level of satisfaction with all specialty programs was above the average (\u0026gt;\u0026thinsp;50%). Eslamipour et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] reported a significant difference in level of satisfaction of dental students with different departments; the students had the highest satisfaction level (in all items) with periodontics and orthodontics departments and the lowest level of satisfaction with endodontics and prosthodontics departments. Despite the differences, the mean level of satisfaction of students with all departments was favorable [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Their results were in line with the present findings.\u003c/p\u003e \u003cp\u003eSatisfaction indicates optimal quality of education in all domains, theoretically and clinically [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Acquiring clinical skills is a key step in healthcare education. Lower satisfaction level of graduates with oral and maxillofacial surgery residency program may be due to extensiveness and diversity of professional topics beyond the basic dental instructions, teaching of clinical skills in a hospital setting, which is significantly different from the university setting, and difficult and heavy workload, which can all adversely affect the level of satisfaction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Diversity of the taught topics and high workload are also present in prosthodontics and endodontics specialty programs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmini et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] discussed that lower level of satisfaction with some clinical fields may be attributed to complexity of the learning process and acquiring the skills, inadequate exposure to clinical scenarios, insufficient practice, and not including the taught skills in daily tasks of undergraduate/postgraduate students. This was also true for the Endodontics Department of School of Dentistry of Tabriz University of Medical Sciences. Although the results of Amini et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] were different from the present findings, the abovementioned reasons may also be applicable to the present study and justify the low satisfaction level of graduates with some items. Fontana et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] suggested that the educational curricula should also include basic science, clinical skills, critical thinking skills for lifelong learning, ethical and professional values, and management skills in order to be able to meet the future needs of graduates and gain their satisfaction. The reported weaknesses of educational programs from the perspective of graduates in almost all professional skills indicate the need for revision of the educational curricula to improve and update the quality of instruction. Zamanzad et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] showed that the main concern of medical students during their internship and externship programs was that they required the instructors to mainly focus on their future needs as a general practitioner. This can be applied to all clinical medical and dental specialty programs as well, and calls for further attention of the authorities to improve the quality of clinical training. Lack of a significant correlation between the grade point average of residents and their satisfaction level in a study by Amanat et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] may be related to discoordination between the educational topics and goals and their method of assessment in different departments. Considering the fact that interdepartmental topics and basic sciences require further coordination and involvement of several instructors, their programming and quality control are more difficult. This is particularly important for interdepartmental and multidisciplinary topics involving orthodontics, prosthodontics, and oral and maxillofacial surgery.\u003c/p\u003e \u003cp\u003eIn the present study, graduates of periodontics program had the highest level of satisfaction with \u0026ldquo;infection control\u0026rdquo;, \u0026ldquo;clinical pharmacology\u0026rdquo;, and \u0026ldquo;medical emergencies\u0026rdquo;, which appears to be partly due to the fact that this program has gained a more integrated structure as the result of diversity of related sciences in the field of periodontics and having a longer history [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Also, the level of satisfaction of graduates with \u0026gt;\u0026thinsp;3 years of work experience was generally higher, particularly in the periodontics program, which may be due to the fact that those with a longer work experience could better perceive and comprehend the actual clinical educational needs in the clinical setting. In total, dental work experience can definitely affect the level of satisfaction with the acquired clinical skills. This aligns with Zamanzad et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], who found medical trainees value future-focused instruction, a principle extendable to dental residency worldwide.\u003c/p\u003e \u003cp\u003eType of university had the greatest effect on level of satisfaction of graduates from oral and maxillofacial surgery, orthodontics, and periodontics residency programs. This finding may be partly due to the extensiveness of the taught topics and the need for stronger interdisciplinary and interdepartmental communications in these fields. This finding highlights the need for revision of educational curricula and balancing the software and hardware facilities in types 1 and 2 universities and Islamic Azad University.\u003c/p\u003e \u003cp\u003eThe growing knowledge and novel equipment underline the need for frequent revisions of clinical educational curricula [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. For instance, it appears that the required number of clinical requirements in the curricula needs to be revised. High number of requests for instruction of micro-endodontics in the endodontics program, supplemental education regarding overdenture and cosmetic procedures in prosthodontics program, fabrication of implant prosthesis in restorative dentistry program, and so on, highlights the need for inclusion of these topics in the logbook of postgraduate students. Also, timing of offering the clinical courses and scientific communication between residents and instructors play fundamental roles in quality of clinical training and satisfaction level of graduates. Consistent with this statement, Amanat et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] discussed that lower level of satisfaction of students with some departments such as Oral and Maxillofacial Surgery Department of School of Dentistry of Shiraz University of Medical Sciences was attributed to inadequate time allocated to scientific communication of students and mentors in the academic environment.\u003c/p\u003e \u003cp\u003eThe personal opinion of the participants was evaluated in this study. The level of achievement of educational goals regarding clinical skills cannot be evaluated without testing the clinical proficiency of graduates [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Risk of bias always exists in studies that are based on personal opinion of the participants, and expectations from themselves and the educational system, interpersonal differences, psychological status of the participants, and their socioeconomic concerns can all affect the results. Brown et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] demonstrated that one strategy to increase the efficacy of self-assessment questionnaires is to use a ranking system instead of quantitative variables. Thus, we used a ranking system in the present study to compare the opinion of the participants. However, Mays and Branch-Mays [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] in a systematic review discussed that graduates should be able to self-assess their capabilities but it is not clear whether this self-assessment can practically yield favorable results. Thus, they suggested an examination to test the clinical skills of graduates to more accurately assess the level of achievement of clinical educational goals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn fact, the present study was a pilot study to pave the way for future investigations. Thus, further studies are required to obtain more accurate results in this respect.\u003c/p\u003e \u003cp\u003eThe present study was conducted on graduates who had passed all the required courses, and were ready to start their practice outside the university setting, and their level of satisfaction with the learned clinical skills was evaluated by designing questionnaires according to the respective educational curricula. Sun et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] stated that the perception of transferable skills of dental and oral health students can be assessed by designing self-assessment scales before and after their graduation, and design educational and clinical programs according to ethical standards. This study can serve as a reliable tool for dental faculty members to assess the perception of students from theoretical and clinical skills. Moreover, the scientific and clinical skills evaluated in this study can play a pivotal role in improving the educational curricula such that the students acquire the required proficiency after successfully completing the program.\u003c/p\u003e \u003cp\u003eAs a pioneering national study in Iran, it provides a baseline for international comparison, despite lacking direct equivalents to compare with. Other limitations of this study include difficulty in concentration due to stressful condition of the board examination, and inadequate exposure to clinical scenarios due to not having adequate work experience outside the university setting. Moreover, the present data were obtained from the participants of the national board dental examination, and do not necessarily reflect the opinion of all general dentists and specialists. In other words, the present study was a preliminary study to pave the way for further investigations in this regard. Thus, future studies are required to obtain more accurate results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGraduate satisfaction with clinical skills training exceeded 50% in all specialties, ranging from 60.0% (oral and maxillofacial surgery) to 79.5% (periodontics), with graduates from Type 1 universities being more satisfied than those from Type 2 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Poor oral and maxillofacial surgery scores reflect the need for more clinical exposure in specialized areas. A model for the assessment of clinical training satisfaction is presented in this article, which can be extrapolated to dental education worldwide. Further curriculum reform should emphasize interdisciplinary education and equality of resources to improve professional competency, with a model that can be used worldwide in dental education.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCVR: Content Validity Ratio; CVI: Content Validity Index; Fig.: Figure; P: P-value; SBMU: Shahid Beheshti University of Medical Sciences; \u0026alpha;: Cronbach\u0026rsquo;s Alpha; SPSS: Statistical Package for the Social Sciences\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent to Participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of the School of Dentistry, Shahid Beheshti University of Medical Sciences (ethical approval code: IR.SBMU.DRC.REC.1399.141). Participants provided informed consent via an online opt-in form prior to completing the questionnaire. They were informed of the voluntary nature of participation, confidentiality, and anonymity of their responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for Publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable, as no individual participant data are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Data and Materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaires used in this study are available as Supplementary File 1. Additional data are available from the corresponding author, Abolfazl Azimi, upon reasonable request. Due to privacy and ethical restrictions, participant data cannot be made publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; Contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBH contributed to conceptualization, methodology, and supervision. NS conducted data collection, analysis, and wrote the original draft. MS contributed to writing, review, and editing, and supervision. AA handled data curation, project administration, writing, review, and editing, and served as the corresponding author. PF contributed to data collection. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the executive members and personnel of the Dental Education Council of the Iranian Ministry of Health and Medical Education for their help in distributing and collecting questionnaires. We also extend our appreciation to the Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran, for providing important resources and support. Additionally, we express our gratitude to the participants of the Iranian national board dental examination for their cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eElangovan S, Venugopalan SR, Srinivasan S, Karimbux NY, Weistroffer P, Allareddy V. (2016). Integration of basic-clinical sciences, PBL, CBL, and IPE in U.S. dental schools\u0026rsquo; curricula and a proposed integrated curriculum model for the future. *Journal Dent Educ 80*(3), 281\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan WP, Wu TY, Hsieh MS, et al. Students\u0026rsquo; view upon graduation: A survey of medical education in Taiwan. *BMC Med Educ. 2012;12(1):127\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassir SH, Sadr-Eshkevari P, Amirikhorheh S, Karimbux NY. (2014). Problem-based learning in dental education: A systematic review of the literature. *Journal Dent Educ 78*(1), 98\u0026ndash;109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWardman MJ, Yorke VC, Hallam JL. (2017). Evaluation of a multi-methods approach to the collection and dissemination of feedback on OSCE performance in dental education. *European J Dent Educ 22*(2), 203\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaart DR, Bitzer EM. (2013). Aligning clinical assessment with course elements in prosthodontic dentistry: A South African case. *Journal Dent Educ 77*(9), 1129\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEslamipour F, Shirban F, Refaei P. (2017). Assessment of dental students\u0026rsquo; satisfaction of clinical departments in Isfahan dental school. *Journal Med Universities Isfahan 10*(5), 625\u0026ndash;33. (In Persian).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasanzadeh SS, Amini A, Shaghaghi A, Hasanzadeh SP. (2002). Results of medical students' satisfaction with the clinical skills department in Tabriz. *Iranian J Med Educ 2*(2), 47\u0026ndash;8. (In Persian).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFontana M, Gonz\u0026aacute;lez Cabezas C, de Peralta T, Johnsen D. (2017). Dental education required for the changing health care environment. *Journal Dent Educ 81*(8), 153\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamanzad B, Moezzi M, Shirzad H. Rate of satisfaction and evaluation of medical students (interns and externs) from the quality of clinical education in the Shahre-kord university of medical sciences-2005. 9*: *Journal of Semnan University of Medical Sciences; 2007. pp. 13\u0026ndash;20. 1(In Persian).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmanat D, Momeni S, Amanat N. Evaluation of the students' attitude and satisfaction of education situation in Shiraz dental school. *Shiraz Univ Dent J. 2010;10(4):356\u0026ndash;60. (In Persian).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShamsi PN, Jafari ZH, Basir M et al. (2019). A self-assessment of senior dental students about acquired skills based on the educational program. *Guilan J, 9*(3), 73\u0026ndash;8. (In Persian).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMays KA, Branch-Mays GL. (2016). A systematic review of the use of self-assessment in preclinical and clinical dental education. *Journal Dent Educ 80*(8), 902\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown GT, Andrade HL, Chen F. Accuracy in student self-assessment: Directions and cautions for research. Principles, Policy \u0026amp; Practice, 22*: *Assessment in Education; 2015. pp. 444\u0026ndash;57. 4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun J, Adegbosin AE, Reher V, Rehbein G, Evans J. Validity and reliability of a self-assessment scale for dental and oral health students' perception of transferable skills in Australia. *European J Dent Educ. 2020;24(1):42\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clinical Skills, Dental Education, Residency Programs, Satisfaction, Curriculum Reform","lastPublishedDoi":"10.21203/rs.3.rs-6264122/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6264122/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIranian dental residency programs' clinical skills training satisfaction assessment is crucial in determining graduates' professional competency at the global scale. This study evaluated Iranian dental residency graduates' satisfaction with clinical skills training, addressing a gap in national-level data.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional, analytical, descriptive study, 500 graduates of seven dental residency programs who took the 2019 and 2020 Iranian national board dental examination were studied. Online pre-examination testing used a validated, reliable researcher-made questionnaire (content validity ratio\u0026thinsp;=\u0026thinsp;0.8, Cronbach's α\u0026thinsp;=\u0026thinsp;0.92) for satisfaction with clinical skills instruction. Participants provided informed consent via an online opt-in form. Data were subjected to Mann-Whitney and Kruskal-Wallis tests in SPSS version 21 (α\u0026thinsp;=\u0026thinsp;0.05) for comparing satisfaction based on work experience and type of university.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eResponse rate was 92.6% (n\u0026thinsp;=\u0026thinsp;463). Range of mean satisfaction with clinical skills was 60% (oral and maxillofacial surgery) to 79.5% (periodontics). Type 1 university graduates were significantly more satisfied than type 2 graduates (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but there were no significant differences between specialties (P\u0026thinsp;=\u0026thinsp;0.053). Satisfaction below 50% was unusual but was notable in oral surgery.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e Satisfaction exceeded 50% across all specialties but was low in oral and maxillofacial surgery (60%) when these complex fields were most in need of it. Internationally, these findings highlight the imperative of matching the clinical curriculum to professional requirements. Residency programs are encouraged to focus more on enhanced clinical exposure and inter-disciplinary training to boost competency, serving as a model for international curriculum change.\u003c/p\u003e","manuscriptTitle":"Level of Satisfaction of Post-Doctoral Graduates with the Instruction of Clinical Skills: A Cross-Sectional Self-Assessment Study in 2019 and 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 11:37:39","doi":"10.21203/rs.3.rs-6264122/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-11T07:12:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T14:06:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T01:54:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T05:58:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217716769110762238898390640234036129664","date":"2025-05-22T07:32:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T10:09:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182704952768768373843808473207746149357","date":"2025-05-19T08:00:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223523872191159992992135510141407290471","date":"2025-05-19T06:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64579272088380927647492943041875239500","date":"2025-05-19T06:18:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152516462293935838288282411784974606081","date":"2025-05-18T23:51:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272389683292675154538462767358886644071","date":"2025-05-16T23:11:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-16T18:51:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T06:09:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-28T15:12:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-04-28T15:11:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cb70192-9a67-4c69-9e1c-d29872b274bc","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T11:40:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 11:37:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6264122","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6264122","identity":"rs-6264122","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}