Employment Preferences and Self-Perceived Confidence of House-Officers across Dental Teaching Institutions of Lahore

Humayon Temoor Baig1, Iqra Ahmed2, Ijaz ur Rahman3, Fiza Ashfaq4, Ahmad Faraz5

  1. Forensic Odonatologist, University of Health Sciences, Lahore
  2. Dentist, University of Lahore
  3. Senior Registrar, University of Lahore
  4. House Officer, Akhtar Saeed Medical and Dental College / Farooq Hospital Lahore
  5. Student, 5th year MBBS, Akhtar Saeed Medical and Dental College, Lahore

Corresponding Author: Iqra Ahmed30-L, Valencia Town, Lahore 54000, Pakistan. Contact Author.
Submission: Mar 31, 2020
Acceptance: Aug 11, 2020
Publication: Oct 16, 2020

© Author(s) (or their employer(s) 2020. Re-use permitted under CC BY. No commercial re-use. Published by Pak J Surg Med. 

Article Citation: Baig HT, Ahmed I, Rehman IU, Ashfaq F, Faraz A. Employment preferences and self-perceived confidence of house-officers across dental teaching institutions of Lahore. Pak J Surg Med. 2020;1(3):e282. doi: 10.37978/pjsm.v1i3.282


Introduction: Despite progressive statistics, the oral healthcare system suffers from an unevenly distributed workforce, lack of infrastructure, and reduced quality of dental education. As a result, dental graduates have decreased job satisfaction and limited career prospects. This article assesses the perceptions of dental graduates regarding their workforce skills, abilities, and employment preferences. Methodology: This was a cross-sectional, questionnaire-based study targeting House-Officers from various randomly selected dental teaching institutes of Lahore. The study tool was a modified version of the questionnaire used by Manakil and George and assessed the perceptions of dental graduates regarding their workforce skills and preferences.[14] This study aimed to evaluate the self-perceived confidence of new dental graduates, and investigate the relationship between gender perceptions. Results: The sample size was 256 House- Officers. Most participants were confident in their skills and abilities with 167 (65.4%) individuals confident in workforce integration, 166 (64.8%) confident in their patient management skills, 154(60.2%) confident in their interpersonal skills, and 163 (63.7%) confident in their leadership abilities. The mentorship was considered to be crucial by 207 (80.9%) individuals. Two hundred and thirty-three (91%) individuals were willing for an additional year of internship and 174 (68%) participants chose city-based employment. The government sector was the most preferred for employment by 122 (47.7%) individuals whereas research was least preferred. Conclusion: Career development and mentorship programs must be put into practice, incentives are provided to work in rural areas and research culture is promoted.

Keywords: Employment, Dental, House officer, Lahore, hospital


Dental teaching institutes are vital in strengthening the oral healthcare system by imparting the necessary skills required to produce competent professionals. The recent mushrooming of private dental institutes has led to a significant improvement in the dentist to population ratio.[1-2] However, the increased number does not guarantee an effective contribution to the dental healthcare system unless essential competencies and skills are acquired.[3] Dental teaching institutions are expected to provide their students with improved competencies, including sufficient clinical training and research opportunities. Nevertheless, there are evident shortcomings in dental education despite advancements in the teaching curriculum from the traditional to the integrated curriculum. The absence of a research culture has led to a shortage of quality faculty. Moreover, dental education and professional competence are inadequately monitored, with malpractice surfacing cases now and then.[4] There is a lack of a regulatory system in our profession, which can have serious dental education consequences in the long run. AA Khan (2018) highlighted that the dental workforce continues to be unevenly distributed, with most dental practitioners centralized in urban areas.[5] Moreover, despite the vast majority of the population with unmet dental needs, many dental practitioners are concerned with a lack of patients unless they are willing to relocate to less profitable rural areas.[5] The lack of patients can be attributed to most dentists being clustered in urban areas, which are home to about 37% of the Pakistani population.[6] With limited oral healthcare awareness in the population, there are limited career prospects, job insecurities, and decreased job satisfaction among the increasing number of dentists.[7-9]
To assess dental graduates’ perceptions regarding their workforce skills, abilities, and employment preferences, house-officers across various dental teaching institutes of Lahore were approached. The house-officers are expected to demonstrate competence in a range of clinical procedures and competence in interpersonal skills, leadership abilities, and patient management. Investigating the self-evaluations of new dental graduates and the differences between gender perceptions is necessary to encourage academic institutions and policymakers to reduce dental graduates’ barriers. Doing so will ensure a workforce that is motivated, well-qualified, and well-prepared for future healthcare initiatives.


Several studies have explored the skills, attitudes, and preparedness of dental students.[10-13] However, this article aims to evaluate the self-perceived confidence of new dental graduates for the workforce, investigate the relationship between this self-evaluation and gender predispositions, and finally, to shed light upon the perceptions of new dental graduates concerning their preferences in order to help educators and policymakers to identify the needs of new dental graduates and address them accordingly. It is necessary to highlight these self-evaluations and perceptions to encourage an environment of increased quality and enhanced motivation for new graduates.

Materials and Methods

This was a cross-sectional, self-reported questionnaire-based study[Supplementary Material 1]. The study tool was a modified version of the questionnaire used by Manakil and George and asked questions about confidence levels in workforce integration, clinical abilities, and employment preferences.[14] To assess dental graduates’ perceptions regarding their workforce skills, abilities, and preferences, House-Officers across various randomly selected dental teaching institutes of Lahore were approached. Through simple random probability sampling, the study population was identified in 5 out of 9 different dental teaching institutes across Lahore & a total of 330 questionnaires were printed and distributed amongst House-Officers employed in University of Lahore, Lahore Medical & Dental College, Fatima Memorial Hospital, Combined Military Hospital, and Sharif Medical & Dental College. The questionnaires were distributed through a third party to maintain anonymity. Data were collected during a period of nearly three months from June 2018 to August 2018. The introductory page clearly stated that the participants’ information was confidential, voluntary, and would solely be used for research purposes. Respondents answered questions about their confidence in integrating into general practice, patient management skills, interpersonal skills, and leadership abilities. The questionnaire also implored the strongest clinical skills, employment preferences, and mentorship. The data collected was coded and entered SPSS v.22 for Microsoft windows. The findings were analyzed by applying descriptive statistics to calculate numbers and percentages. A p-value >0.05 was considered to be significant. The researchers were permitted to carry out their research work by the University of Lahore’s ethical review board. (Ref no: UCD/ERCA/18/02a, dated 19.03.2018).  Everyone had an equal chance to participate. However, incomplete questionnaires and questionnaires were excluded from the data.


Out of the 330 questionnaires distributed, 270 questionnaires were returned. After the exclusion of incomplete questionnaires, the sample size was 256 House- Officers. Hence the response rate was calculated to be 77.6%. Out of the 256 House-Officers responding to the questionnaire, 181 (70.7%) were females, and 75 (29.3%) were males. Two hundred and fourteen (83.6%) of the participants were in 20 to 24 years. Participants were most confident in their workforce abilities and skills: One hundred and sixty-seven (65.4%)individuals were confident in workforce integration. One hundred and sixty-six (64.8%) were confident in their patient management skills. One hundred and fifty-four (60.2%) were confident in their interpersonal skills, and 163 (63.7%) were confident in their leadership abilities. (Graph 1). Regarding gender-based differences in confidence levels, males were comparatively more confident regarding smooth integration into the workforce, patient management skills, interpersonal skills, and leadership abilities[Graph 1].
The mentorship was considered a crucial factor for participants, with 207 (80.9%) indicating that it was imperative to have a mentor during the first few years in clinical practice. Two hundred and thirty-three (91%) individuals were willing for an additional year of internship. Concerning employment preferences, 174 (68%) participants chose city-based employment over a rural-based one, and 234 (91.4%) participants were keen on opening an independent practice. When given a choice to practice in a partnership, sole or as an employee, 86 (47.5%) females preferred to work as employees, whereas 32 (42.7%) males showed more preference towards partnerships [Table 1]. The government sector was the most preferred for employment by 122 (47.7%) individuals, followed by the private sector, which was preferred by 87 (34%) individuals). University & Research, Defense, and Management were not as preferred [Graph 2]. Regarding areas of strongest experience, 56 (74.7%) males were more confident in their restorative skills than 105(58%) females. 46 (25.4%) females were more confident in their periodontology skills than 7(9.3%) males [Table 2].
The questionnaire also included an open-ended question inquiring about any novel subject that should be made in the future? The answers ranged from Forensic Odontology, Maxillofacial Radiology, Esthetic dentistry, Communication skills, Dental Entrepreneurship, and additional clinical training in Orthodontics & Implantology.

Table 1 shows the difference between male and female areas of strongest experience
Graph 1 - demonstrates differences in confidence levels between males and females. 54 (72%) males were confident in their patient management skills as compared to 112 (61.9%) females. 51(68%) males were confident regarding interpersonal skills compared to 103(56.9%) females. 50 (66.7%) males showed confidence in their leadership abilities compared to 113(62.4%) females.
Table 2 demonstrates the differences in preference of practice in males and females
Graph 2 indicating the preferred employment of male and females. The government sector was most preferred followed by the private sector. Research, management and defense sectors were not as preferred.


Many respondents were confident in their patient management skills, interpersonal skills, and leadership abilities, with males demonstrating more confidence than their female counterparts. The differences in gender predisposition towards confidence demonstrated in this study followed numerous other studies such as the one done at Cornell University, which indicated that men often overestimated their work performance and abilities, whereas women tended to underestimate both.[15-17] An internal report by Hewlett Packard in 2018 showed that men applied for a job or promotion when they met 60% of the qualifications, but women applied only if they met 100% of them.[18] This could be attributed to a finding by previous studies showing that women tended to underestimate their abilities even if they were high achievers.[19-20] These findings indicated that female participants of this study might have been capable, competent, and high achievers but underestimated themselves and, as a result, were not as confident in their abilities. More women showed their preferences to work as employees, whereas males preferred partnerships. This finding can be supported by a study showing that females were less confident regarding their work performance and anticipated less support from team members when in a leadership position.[21] Additionally, males regarded restorative dentistry as their most substantial area of experience. This can be compared to a recent study that found that male dental students had a better perception of facial and dental aesthetics.[22] This finding is also comparable to a study at The University of Hong-Kong that new graduates were more confident regarding restorative dentistry than other areas of general dentistry.[23]
City-based practices were preferred over rural-based ones. This finding has also been demonstrated in studies across the world where even though half of the world’s population is based in rural areas, only a quarter of health professionals prefer employment there.[24-26] This can be due to a lack of incentives, difficulty in professional career growth, and unfavorable living and working conditions.
This is a cause of concern as oral cancer is a significant public health issue globally, the second most common malignancy in Pakistan and the dentist-population ratio continues to be alarmingly uneven across the nation with a dire need for Dental Surgeons to be employed in poorly developed rural areas.[27-29]
There was a lack of interest in research, with most of the participants opting for government and private practices. This can be attributed to insufficient research funding of public universities and the lack of vision and dedication of private academic institutions.[30] As a result, there will be a lack of substantial research and low-quality work that will not meet global requirements.[31-32] An overwhelming majority of participants were keen on an additional year of internship and expressed a need for being mentored. Similarly, a survey by the American Dental Association demonstrated that over 80% of dental students were interested in mentorship programs.[33] Mentoring has been depicted to provide education and training that strengthens workforce capacities and capabilities and aids in individuals’ personal and professional growth.[34-35] Mentorship programs have also been indicated as an empowering tool for men and women alike as these lead to career optimism and leadership readiness, personal satisfaction and professional development, and lower levels of dropout.[36-38]
Although Pakistan has gradually improved its healthcare delivery system, it is still necessary to take healthy initiatives to better the oral health sector.[39] As indicated by this study, female dentists are less confident in their workforce abilities. To empower them, programs need to be put into place to encourage leadership, healthy communication skills, and inclusivity. Openness in idea exchange needs to be practiced while respecting that males and females can have equally good ideas.[40] A research culture needs to be embedded at the undergraduate level, where institutional departments need to be at the forefront of research promotion. Moreover, incentives to work in rural areas must be provided, such as establishing rural and urban healthcare connections, improving the quality of facilities, career development programs, and financial incentives.


This study has illustrated new dental graduates’ perceptions regarding critical topics such as employment preferences, attitudes towards mentorship, and self-evaluation of confidence levels. Career development and mentorship programs must be put into practice, incentives are provided to work in rural areas, and research culture is promoted. This article aimed to shed some light on these issues for decision-makers to correctly identify the compensatory measures to be taken to better the Oral healthcare system.


This study has potential limitations such as the sample’s readiness for participation, difficulties in distributing and collecting filled questionnaires. The study was also limited in time and resources. Besides, one individual’s perception of the questions may be influenced by the department they were working in at the time of answering the questionnaires.


  1. Awan A.K. Trading-off quality for quantity: Mushrooming of Medical Institutions and Quality of Medical Education in Pakistan. Int J Pathol. 2016;14(1):1-6
  2. Latif MZ, Wajid G. Reforming Medical Education in Pakistan through strengthening Departments of Medical Education. Pak J Med Sci. 2018;34(6):1439‐1444. Available from: doi:10.12669/pjms.346.15942
  3. Khan AW, Sethi A, Wajid G, Yasmeen R . Challenges towards quality assurance of Basic Medical Education in Pakistan. Pak J Med Sci. 2020;36(2):4-9. Available from: doi: 10.12669/pjms.36.2.1319
  4. Dayan F, Gulaly, Sheraz M.M. Holding Healthcare Accountable: A Solution to Mitigate Medical Malpractice in Pakistan. IJHHS. 2020; 4(3): 161-173. Available from: doi: 10.31344/ijhhs.v4i3.195
  5. Khan A.A. Dentistry in Pakistan-Standing at the Crossroads Facing Numerous Challenges with an Uncertain Future. JPDA. 2018; 25(1):1-2.
  6. Statista Research Department. Urban population in Pakistan from 2005 to 2018 (in thousands)[Internet]. 2020 [accessed on 2020 Mar 29]. Available from: https://www.statista.com/statistics/603498/pakistan-urban-population/
  7. Nadeem M, Khan S, Ahmed F, Ahmed S. Oral health awareness, behavior and attitude of Pakistani population towards dental treatment. International Journal of Dental Clinics. 2012;4(4):6-9.
  8. Yousuf W, Kazmi SM, Quraeshi S, Khan M. Motivation and Future Intentions of Dental Students in Karachi, Pakistan. Pak J Med Res. 2019;58(1):26-30.
  9. Ali A, Azeem M, Bhutto N, & Shaikh S.R. Determinants of Job Satisfaction among Dentists Working in Teaching Hospitals in Karachi, Hyderabad and Islamabad. Journal of Dental and Craniofacial Research. 2017;2(1):1-9
  10. Ray M, Milston A, Doherty P, Crean S. In their own words: investigating the preparedness of final year dental students in the UK for independent general dental practice. Br Dent J. 2018;225(4):340-349. Available from: doi: 10.1038/sj.bdj.2018.646. Epub 2018 Aug 17. 
  11. Gilmour AS, Welply A, Cowpe JG, Bullock AD, Jones RJ. The undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff. Br Dent J. 2016;221(6):349-54. Available from: doi: 10.1038/sj.bdj.2016.686.
  12. Ali K, Cockerill J, Zahra D, Qazi HS, Raja U, Ataullah K. Self-perceived preparedness of final year dental students in a developing country-A multi-institution study. Eur J Dent Educ. 2018;22(4):e745-e750. Available from: doi: 10.1111/eje.12389. Epub 2018 Aug 11. 
  13. Imtiaz M. Intention & knowledge of fresh dental graduates of FMH College of dentistry Lahore related to dental practice management. Health Professionals Educator Journal. 2019;2(1): 15-20.
  14. Manakil J, George R. Self-perceived work preparedness of the graduating dental students. Eur J Dent Educ. 2013 May;17(2):101-5. Available from: doi: 10.1111/eje.12016. Epub 2012 Dec 6. 
  15. Carlin B.A, Gelb B.D, Belinne J.K, Ramchand L. Bridging the gender gap in confidence. Bus Horiz. 2018; 61(5): 765-774.  Available from: doi: 10.1016/j.bushor.2018.05.006.
  16. Herbst T.H.H. (2020). Gender differences in self-perception accuracy: The confidence gap and women leaders’ underrepresentation in academia. SAJIP. 2020; 46(1): 1-8. Available from: doi: 10.4102/sajip.v46i0.1704
  17. Ford, H.L., Brick, C., Blaufuss, K. et al. Gender inequity in speaking opportunities at the American Geophysical Union Fall Meeting. Nat Commun. 2018; 9:1358. Available from: doi: 10.1038/s41467-018-03809-5
  18. Zenger J. The confidence gap in men and women: why it matters and how to overcome it[Internet]. Forbes 2018. 2018[accessed on 2020 Mar 25]. Available from: forbes.com/sites/jackzenger/2018/04/08/the-confidence-gap-in-men-and-women-why-it-matters-and-how-to-overcome-it/#693bf0e43bfa. 
  19. Parkman, A. The Imposter Phenomenon in Higher Education: Incidence and Impact. Journal of Higher Education Theory and Practice. 2016; 16(1):51-60.
  20. Clance P.R, Imes S.A. The imposter phenomenon in high achieving women: Dynamics and Therapeutic intervention. Psychotherapy: Theory, Research and Practic. 1978;15(3):241- 247. Available from: 10.1037/h0086006
  21. Born A, Ranehill E, Sandberg A. A Man’s World? The Impact of a Male Dominated Environment on Female Leadership.  Working Papers in Economics 744, University of Gothenburg, Department of Economics. 2019. Available from: doi: 10.2139/ssrn.3207198
  22. Alhammadi, MS, Halboub, E, Al‐Mashraqi, AA, et al. Perception of facial, dental, and smile esthetics by dental students. J Esthet Restor Dent. 2018;30:415–426. Available from: doi: 10.1111/jerd.12405
  23. Yiu CK, McGrath C, Bridges S, Corbet EF, Botelho MG, Dyson JE, Chan LK. Self-perceived preparedness for dental practice amongst graduates of The University of Hong Kong’s integrated PBL dental curriculum. Eur J Dent Educ. 2012;16(1):e96-e105. Available from: doi: 10.1111/j.1600-0579.2011.00681.x. Epub 2011 Feb 17. 
  24. Dumont J.C et al. International mobility of Health Professionals and Health workforce management in Canada, Myths and Realities[Internet]. OECD Health Working Papers 40. OECD & WHO. 2008[accessed on 2020 Mar 25]. Available from: https://www.who.int/hrh/migration/Case_study_Canada_2008.pdf?ua=1
  25. Steinhäuser J, Annan N, Roos M et al. Approached to reduce shortage of general practitioners in rural areas – results of an online survey of trainee doctors. Dtsch Med Wochenschr. 2011;136(34-35):1715-9. Available from: doi: 10.1055/s-0031-1272576 
  26. Sultana, A., Awais, S., Mughal, A., & Anwar, B. FACTORS AFFECTING WILLINGNESS OF DOCTORS TO WORK IN RURAL AREAS OF PAKISTAN. Pakistan Journal of Public Health. 2017;7(2):100-104. Available from: doi: 10.32413/pjph.v7i2.43
  27. Imtiaz A S,Hurtamina K, Riaz S, Mahum H, Muhammad R D, et al. Oral Cancer Frequency at Different Sub Sites Presenting At a Tertiary Care Hospital in Karachi Pakistan. Glob J Oto: 2017;6(3):555687. Available from: doi: 10.19080/GJO.2017.06.555687
  28. Basharat S, Shaikh BT, Rashid HU, Rashid M. Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study. BMC Health Serv Res. 2019;19(1):715. Available from: doi: 10.1186/s12913-019-4521-3. Erratum in: BMC Health Serv Res. 2019 Nov 14;19(1):835. 
  29. Ahmad Z, Idrees R, Fatima S, Uddin N, Ahmed A, Minhas K, Memon A, Fatima SS, Arif M, Hasan S, Ahmed R, Pervez S, Kayani N. Commonest Cancers in Pakistan – Findings and Histopathological Perspective from a Premier Surgical Pathology Center in Pakistan. Asian Pac J Cancer Prev. 2016;17(3):1061-75. Available from: doi: 10.7314/apjcp.2016.17.3.1061
  30. Jahangir G.Z. The Need of Research Culture in Pakistan[Internet]. The Scientific Ravi. 2012 [accessed on 2020 Mar 25]. Available from: https://pdfs.semanticscholar.org/9dd8/2bd841ce24ed505c1140e3becc214259732f.pdf
  31. Nauman S. Lack of critical thinking skills leading to research crisis in developing countries: A case of Pakistan. Learned Publishing. 2017; 30: 233–236. Available from: doi: 10.1002/leap.1091
  32. Hassan SU. Research landscape of Pakistan. MIT Technology Review, Pakistan[Internet]. 2016[accessed on 2020 Mar 25]. Available from: http://www. technologyreview.pk/research-land-scape-of-pakistan
  33. American Dental Association. Guidelines for an Effective Mentorship – The Making of a Mentor[Internet]. [accessed on 2020 Mar 25]. Available from: http://tbachmarketing.com/TBACH_Marketing/Portfolio_files/mentor_guidelines.pdf
  34. Balogun O.D, C. Nwachukwu, S. Grover, et al. Workforce Capacity and Capability Building Through Metrics-Based Mentoring Partnership. J Glob Oncol. 2018; 4(2).60s-60s. Available from: doi: 10.1200/jgo.18.76700 
  35. Stewart L.A, Baillie L, Woods S. Health care staff perceptions of a coaching and mentoring programme: A qualitative case study evaluation. IJEBCM. 2017;15(2):70-85. Available from: doi: 10.24384/000251
  36. Jakubik LD, Eliades AB, Weese MM. Part 1: An Overview of Mentoring Practices and Mentoring Benefits. Pediatr Nurs. 2016;42(1):37-8. PMID: 27019941.
  37. Schmidt E.K, Faber S.T.Benefits of Peer Mentoring to Mentors, Female Mentees and Higher Education Institutions, Mentoring & Tutoring: Partnership in Learning. 2016; 24(2):137-157, Available from: doi: 10.1080/13611267.2016.1170560
  38. Kurji Z, Premani ZS, Mithani Y. Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward. J Ayub Med Coll Abbottabad. 2016;28(3):601-604. PMID: 28712245.
  39. Tabar P. Girl power: 5 ways to empower female physicians[Internet]. 2018[accessed on 2020 Mar 26]. Available from: https://www.physicianspractice.com/article/girl-power-5-ways-empower-female-physicians/page/0/1 
  40. Rana SA, Sarfraz M, Kamran I, Jadoon H. Preferences Of Doctors For Working In Rural Islamabad Capital Territory, Pakistan: A Qualitative Study. J Ayub Med Coll Abbottabad. 2016;28(3):591-596. PMID: 28712243.


We would like to thank Dr Muhammad Hassan (University of Lahore) for his comments on the manuscript.


HTB: Conceptualization, Methodology, Writing (review & editing)
IA: Investigation, Writing (original draft), Formal analysis
IR: Project administration
FA & AF: Investigation, Formal analysis

Ethical Consideration

Institutional Review Board of the University of Lahore granted ethical approval to authors on 19 Mar 2018 vide letter number UCD/ERCA/18/02a

Conflict of Interest

The author declared no conflict of interest.


We Value your Opinions. Register your Opinion to this Original Article by Baig HT et al. by clicking here.

Manuscript Processing

Submission: PJSM-2020-000152-O21-Apr-2020
Acceptance: 11-Aug-2020
Publication: 16-Oct-2020

Editorial Team

This article has been subjected to extensive editing and double blind peer review process. The following editors were involved in editing of this article;
Lead Editor: S Masud
Stats: S Firdous
Editors: A Sarfraz, A Zulfiqar, J Siddiq, Z Sarfraz, K Zahra, A Anwer 
Bibliography: Z Sarfraz

Publisher’s Note

The views and opinion expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.

Supplementary Material

All the data shared is under terms of CC BY. The Supplementary Material includes

  1. Questionnaire in PDF format size less than 1000 kb can be accessed from this URL: https://wp.me/abyAqB-Dt
  2. Additional tables and graphs in PDF format, size less than 500 kb, can be accessed from this URL: https://wp.me/abyAqB-DF