|Year : 2016 | Volume
| Issue : 2 | Page : 77-81
Clinical anxiety-provoking situations among dental students in Chennai
B Abinaya Lakshmi, C Joy Fammina, R Ganesh
Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||19-Dec-2016|
B Abinaya Lakshmi
1st Street, Old Perungalathur (Post), Chennai - 600 063, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Aims: The dental clinical setting is a significant learning environment for dental undergraduates which may induce anxiety, which adversely affects the clinical performance. Hence, the aim of this study was to determine the clinical anxiety-provoking situations among dental students in Chennai. Subjects and Methods: A questionnaire-based cross-sectional survey was conducted among 375 clinical dental students in Chennai. The questionnaire used in the study consisted of 37 clinical anxiety-provoking situations. The situations were assessed using a 4-point Likert scale. The questionnaire was distributed and the students completed the questionnaire under the supervision of research assistance, who collected the completed questionnaires immediately for evaluation. Statistical Analysis Used: Data were analyzed by computerized SPSS (version 21). Results: Of the 375 respondents, 21% were male and 78.8% were female. About 98.7% of the population reported anxiety with the majority of study population experiencing moderate anxiety. Examination failure (88%), meeting clinical requirement (82.5%), fracturing a tooth while extraction (94%), extracting a wrong tooth (92%), and getting infected by the patients (92.7%) were considered as more common clinical anxiety-provoking situations. Conclusion: The challenges and stress at different stages of dental education may elicit and increase the level of anxiety which can be prevented by creating a friendly learning environment for better learning with less anxiety and fear
Keywords: Anxiety, dental, Likert scale
|How to cite this article:|
Lakshmi B A, Fammina C J, Ganesh R. Clinical anxiety-provoking situations among dental students in Chennai. Indian J Oral Health Res 2016;2:77-81
|How to cite this URL:|
Lakshmi B A, Fammina C J, Ganesh R. Clinical anxiety-provoking situations among dental students in Chennai. Indian J Oral Health Res [serial online] 2016 [cited 2019 Jul 15];2:77-81. Available from: http://www.ijohr.org/text.asp?2016/2/2/77/196112
| Introduction|| |
Anxiety is a subjective sensation with a varied degree of perception. Anxiety includes a wide range of strong external stimuli which can be both physiological and psychological problems. As a human being, everyone has an anxiety toward different issues. However, the level of anxiety varies among different age groups. Among them, students at their teenage level are considered to experience increased levels of anxiety while compared to others.
Clinical anxiety is the emotional reaction that health professionals face before delivering health care. This anxiety occurring at the transition from preclinical to clinical stage is specific in health career training. 
According to a 2008 report of the Global Congress on Dental Education, "dental education is regarded as a complex, demanding, and often stressful pedagogical exposure. It involves an acquisition of required academic, clinical, and interpersonal skills during the course of learning,"  which can be fear of finishing quotas, failure of exams, fulfilling the needs of patients, etc.
It is known that anxiety can be beneficial or harmful depending on the severity. Minimal anxiety is good for students because it makes them task oriented and aids concentration. However, excessive anxiety, on the other hand, can be very debilitating, increases the risk of suffering illness, decreases learning, impairs performance, and undermines optimal healthcare delivery. 
Clinical training for dental students remains undisputedly a vital component of the dental education offering a wide variety of learning. This exposure to the reality of professional practice in the clinic is essential in producing skilled clinicians. However, the learning that occurs in clinical settings presents challenges that may cause students to experience anxiety. 
Hence, the objective of this study was to determine the clinical anxiety-provoking situations among dental students in Chennai.
| Subjects and methods|| |
A cross-sectional study was conducted among final year students and Compulsory Rotary Residential Internship (CRRI) of four randomly selected dental colleges in Chennai regarding clinical anxiety-provoking situations in January 2016. The study was approved by the Institutional Review Board of Priyadarshini Dental College and Hospital, and permission to conduct the study was given by the Ethical Committee of Priyadarshini Dental College and Hospital.
The estimated sample size was 382 based on 90% power with an α error of 0.05. The sample size was estimated using Fisher's exact test.
Prior authorization was obtained from the Principal of each Dental College, after brief description about the aim and purpose of the study. The investigators met the head of the department of each specialty and got the necessary permission to contact the students. Each department students were explained about the survey, after which the questionnaire was distributed to the participants.
[Additional file 1]
The questionnaire contained 37 clinical anxiety-provoking situations. The situations were assessed using a 4-point Likert scale from "not anxious," "slightly anxious," "fairly anxious," to "very anxious." For the purpose of analysis, response was scored 1 for not anxious, 2 for slightly anxious, 3 for fairly anxious, and 4 for very anxious. Demographic variables such as age and gender were also collected.
The students were instructed to give their own answer and discussion was not permitted. After answering, the questionnaire was collected for evaluation.
The data collected were entered into MS Excel sheet and analyzed using Statistical Package for the Social Science (Version 21.0 Armonk, NY: IBM Corp.) Software version 21.0. Mann-Whitney test for gender difference was also applied. P < 0.05 was considered statistically significant.
| Results|| |
The study participants included 385 dental students, of which 81 (44.4%) were male and 304 (55.6%) were female. The age group of participants ranged from 20 to 25 years. [Figure 1] shows the more common clinical anxiety-provoking situations among dental students. [Figure 2] shows how anxious are study subjects to examination failure. [Figure 3] shows the anxiety level of the study subjects while extracting a tooth. [Table 1] shows the level of clinical anxiety-provoking situations among dental students in Chennai.
|Figure 3: Level of anxiousness of study subjects while extracting the tooth|
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|Table 1: Clinical anxiety-provoking situations among dental students in Chennai|
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| Discussion|| |
Medical school has been long recognized as involving numerous stressors that can affect the well-being of the student. The mental status of medical students has been an important issue to be taken under consideration, reported in 1956.  Clinical training includes learning clinical procedures, completion of quotas coupled with attending lectures, and studying for examinations require dental students to work harder adding overall stress and anxiety.
Identification of potential problems is important in dental education programs as it might give students, faculty, and administrators an opportunity to take precautionary measures to prevent clinical anxiety and stress. 
In this study, the overall prevalence of clinical anxiety among participants was 99.7% with majority experiencing a moderate level of anxiety which is similar when compared to the Obarisiagbon et al.,  where they conducted a study among Nigerian dental students, which is 98%.
In this study, extracting a wrong tooth, getting infected by patients, examination failure, and fracturing a tooth while extraction are the top most clinical anxiety-provoking situations which is similar to the study conducted by Kieser and Herbison,  in New Zealand dental students.
It has been established from the previous study on clinical medical and nursing students that fear of making mistakes is one of the significant causes of anxiety. 
In developing countries, tooth extraction is the common dental procedure performed in dental clinics. In this study, about 44.4% of study population experience severe anxiety while tooth extraction which is more commonly associated with extracting a wrong tooth and fracturing a tooth during extraction which is similar to study conducted by Obarisiagbon et al.  among Nigerian clinical dental students. This may be due to the presence of complications from this procedure which may be considered simple by the general public.
In the present study, the completion of clinical cases and quotas are considered as an anxiety-provoking situation by 82.3% of the study population, which is similar to the study conducted by Sekhon et al.  among Dental College students in India.
The completion of clinical cases and quota is one of the requirements for qualification of examination; hence, study population may consider completion of clinical cases and quotas as a clinical anxiety-provoking situation.
The possibility of dental professional getting infected by patients during the care delivery procedures induces anxiety among 91.2% of the study population which is similar to the studies conducted by Moss and McManus  among students of London and Kieser and Herbison  among dental students in New Zealand. This may be due to the lack of knowledge or practice of students in infection prevention measures.
About 31.3% of the study population reported moderate anxiety while treating a child patient which is similar to the study conducted by Telang et al. in which 31% of Malaysian dental students reported anxiety. This may be due to the lack of confidence and skills regarding management of child patients and lack of patient cooperation.
There has been a stigma, negative attitudes, and various forms of discrimination toward psychiatric patients among different categories of healthcare workers. About 40% of the study population experience severe anxiety while treating a psychiatric patient; this may be due to poor knowledge and awareness about psychiatric conditions and their management. This is similar to the study conducted by Kalaa et al.  among dental students in Turkey.
To the best of our knowledge, this is the first of its kind in Chennai to determine clinical anxiety-provoking situations among dental students. It is shown that the highest anxiety was due to the lack of confidence and fear of making mistakes which might cause disappointment and stress among students. If the sources can be identified and targeted, early barriers to learning can be minimized.
| Conclusion|| |
Data from this study revealed that clinical anxiety of moderate severity is more prevalent among dental students. This may be due to challenges and stress at different stages of dental education. However minimal anxiety is good for students as it aids in concentration, alertness, etc. Excessive anxiety on other hand can affect the overall performance of students. This can be prevented by creating a supportive learning environment to enhance student confidence level which helps in better learning with less anxiety and fear.
- Introduction of orientation course like practical application of infection prevention measures which may help students during clinical training
- Student confidence can be enhanced by more interactive classes regarding skills and management of patients
- In case of quota-based system in education, it can be shifted from quantity of cases to quality of cases.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]