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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 82-87

Assessing stress and burnout in dental students in a dental institution

1 Department of Public Health Dentistry, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
2 Department of Public Health Dentistry, Pacific Dental College and Hospital, Partapura, Udaipur, Rajasthan, India

Date of Submission16-May-2021
Date of Decision07-Sep-2021
Date of Acceptance07-Sep-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Avijit Avasthi
Department of Public Health Dentistry, Bhojia Dental College and Hospital, Baddi - 173 205, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_11_21

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Background: Dental students feel stress in their professional education such as fear of examinations, burden of workload, stress in completion of academic course, and adjustment in college atmosphere. The objective of the study was to assess stress among dental students and its association with academic year of training and gender differences in perceived stress. Materials and Methods: A 31-item self-constructed Modified Garbee's Dental Environmental Stress Survey (1980) Questionnaire was distributed among students to obtain their stress response on a 4-point Likert scale with responses ranked: 1 – not stressful, 2 – slightly stressful, 3 – moderately stressful, and 4 – very stressful. Statistical analysis was done using the Statistical Package for the Social Sciences version 21.0, Armonk, NY, USA: IBM Corp. Results: Responses were obtained from 232 students; 74.2% were female and 24.6% were male. Top stressors were fear of failure, insecurity of future, stress of examinations, fear of excessive workload, assigned work burden, unavailability of clinical cases, the lack of time to complete work, less time for recreation, coping with competition among classmates, lack of confidence in career decision, receiving criticism of work from teachers, and the lack of confidence to be successful student. Less stressful responses were difficulty in learning preclinical procedures, learning environment created by faculty, the attitude toward faculty, relationship with colleagues, financial stress, impact on personal health, discrimination due to race, class, etc., The mean stress scores were more in preclinical years (BDS 1st and 2nd years) when compared to clinical years (BDS 3rd and 4th years). Stress perceived by female students outweighed male students. Conclusion: Therefore stress reduction strategies need to be incorporated in dental curriculum.

Keywords: Fear, perception, students

How to cite this article:
Avasthi A, Aasdhir SS. Assessing stress and burnout in dental students in a dental institution. Dent Med Res 2021;9:82-7

How to cite this URL:
Avasthi A, Aasdhir SS. Assessing stress and burnout in dental students in a dental institution. Dent Med Res [serial online] 2021 [cited 2023 Jan 30];9:82-7. Available from: https://www.dmrjournal.org/text.asp?2021/9/2/82/331389

  Introduction Top

Dentists and medical professionals experience several challenging problems on daily routine. One of the problems faced is stress. Dental students, both undergraduates and postgraduates, experience work-related stress such as fear of academic grades, frequent examinations, excessive workload, meeting course completion deadlines, socioeconomic pressures, relationship with peers and teachers, and signs of psychological morbidity in their professional training. Professional training which includes academic and clinical practice generates substantial stress resulting in inefficiency causing failure to achieve maximum productivity.[1],[2]

Stress has a considerable toll on health of dental students which generates symptoms of anxiety, depression, tension, fear, headache, dizziness, fatigue, insomnia, and impairment of immune system.[3] Meeting the expectation of parents generates stress on students which affects their academic performance. In Indian context, students are entirely relying on their parents to fund their educational expenses which could result in financial burden.[4] Studies in Indian population assessing stress among dental students are well documented, but the ability to cope with the stress should be explored. Most of the existing literature in evaluation of stress is in the Western part of the world.[3],[5],[6] The teaching faculty and administrators can list out the determinants of stress and modify the dental curriculum to prevent the onset of stress faced by dental undergraduates in their professional training. Thus, the aim of the study is to assess the level of stress and burnout in dental undergraduates and to assess its association with year of training.

  Materials and Methods Top

The study was conducted among undergraduates and interns in a dental college in Himachal Pradesh by distributing printed 31-item self-constructed Modified Garbee's Dental Environmental Stress Survey (1980) Questionnaire to the participating students. The 31-Item Stress Questionnaire form assessed stressor response on a 4-point Likert Scale, with responses ranked: 1 – not stressful, 2 – slightly stressful, 3 – moderately stressful, and 4 – very stressful. The design of the study was cross sectional, and permission to conduct the study was obtained from the Institutional Ethical Committee of the institution through letter number (BDC/BUDH/1180) dated February 18, 2019. Informed consent was obtained from all students who expressed their willingness to be enrolled in the study and their anonymity was maintained. All printed questionnaire forms were distributed through class representative of every academic year (BDS 1st to final year and interns) and he/she thoroughly checked the completeness of questionnaire forms and respondents who left incomplete questionnaire forms were reminded to re-submit the complete questionnaire forms. Final sample size comprised 232 BDS undergraduates including interns, of which 58 were BDS 1st year, 43 BDS 2nd year, 42 BDS 3rd year, 50 BDS final year, and 39 BDS students doing internship. 95% was the response rate obtained since 11 students were excluded due to their refusal. Pretesting of the questionnaire was done among small sample to assess the validity of the questionnaire, and the internal consistency obtained was (Cronbach's alpha α = 0.90). The data obtained were entered in Microsoft Excel Sheet and statistically analyzed using the Statistical Package for the Social Sciences version 21.0, Armonk, NY, USA: IBM Corp. Descriptive statistics and inferential statistics were conducted. Comparison was done with academic year of training using One-way ANOVA followed by post hoc Tukey test. Gender differences in perceiving stress were compared using independent sample t-test.

Differences in stress experienced across all five academic years were compared using one-way ANOVA and post hoc Tukey.

  Results Top

Two hundred and thirty-two students participated in the study with age ranging from 17 to 23 years. Female students (74.2%) outnumbered male students (24.6%). The mean age of participants was 19.7 ± 1.74 years. [Table 1] shows the mean stress score of all 31-stress responses and comparison between different academic years from BDS 1st year to those pursuing internship. Top stressor was fear of failure (3.84 ± 1.17), followed by insecurity about professional future (3.75 ± 1.08) with statistical significance (P < 0.004). Facing examinations and obtaining good grades in course resulted in pressure (3.74 ± 1.08) with significant difference (P < 0.016). The fear of being unable to keep up with excessive workload (3.73 ± 1.02) and pressure of assigned work burden (3.68 ± 0.97) were statistically significant (P < 0.000). Students expressed significant stress (P < 0.001) of unavailability of patients at prescribed time for treatment or examination (3.59 ± 1.12), the difficulty in course work (3.55 ± 0.50), and lack of time to do assigned college work (3.54 ± 1.05) with significant finding (P < 0.004). Certain students communicated less time spent toward recreation and relaxation in the busy hectic schedule (3.50 ± 1.06) which was statistically significant (P < 0.001).
Table 1: Comparison of mean dental environment stress questionnaire score using ANOVA and post hoc Tukey

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Stress of facing the professional college versus reality (3.46 ± 1.04) was also high, followed by lack of home atmosphere in hostels (3.40 ± 1.15). Competition among peers (3.37 ± 1.03) was found to be statistically significant (P < 0.000).

Students perceived less stress in taking decisions about their career (3.33 ± 1.07), following rules and regulations of the dental college (3.21 ± 1.12), and receiving criticism about their work from teaching faculty (3.19 ± 1.02). Similarly, they encountered less strain while working on patients with poor personal hygiene (3.17 ± 1.00) and undertaking responsibility for comprehensive patient care (3.13 ± 0.94). The lack of confidence to be successful professional student (3.17 ± 1.03) was not as much. No tension was felt by students in relation to attitude of faculty toward professional student (2.99 ± 1.02). Less distress was felt while learning preclinical procedures (2.96 ± 0.92) and acquisition of skills in undertaking clinical laboratory work (2.96 ± 0.89). Similarly, less burden was felt while coping with other students (2.84 ± 0.98) and less strain was reported financially (2.93 ± 1.04). The effect of stress on personal health (2.93 ± 0.99) was substantially low and less pressure was exerted by the learning environment created by teaching faculty (2.80 ± 0.90). However, the stress of cheating in professional college (2.80 ± 1.36) was significant (P < 0.001).

Very limited stress was observed in context to students managing dual responsibility of spouse and student (2.47 ± 0.78), discrimination due to race, class status (1.44 ± 0.68), having children at home (1.03 ± 0.18), and adjustment in relationships (1.01 ± 0.14).

[Table 2] shows differences in mean stress perceived in relation to gender. There were a significant difference in assigned work burden felt by male and female students, t (230) = −3.409, P = 0.001, and a noticeable difference regarding insecurity of future reported by male and female students, t (230) = −2.090, P = 0.038.
Table 2: Gender differences in mean dental environment stress using independent t-test

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  Discussion Top

Overall, the study findings revealed that students in preclinical years (BDS 1st and 2nd years) were more stressed out in comparison with students in clinical years (BDS 3rd and 4th years).

Assigned work burden was more stressful in 2nd-year students when compared with 3rd-year students and interns (P < 0.000) and this finding matched with studies outside India.[5],[6] Fear of performance in examinations was higher in preclinical years (BDS 1st and 2nd years),[5],[6] but European students had higher stress in transition to clinical years (BDS 3rd and 4th years).[7] The expectation of pursuing carrier in professional college versus reality was stressful in preclinical years (BDS 1st and 2nd years) and gradually increased during clinical years (BDS 3rd and 4th years) in agreement with previous studies outside India.[5],[6],[8] Insecurity about future aggravated stress with each passing year, which was due to lack of jobs in government sector and the difficulties faced in running private dental clinics.[8],[9],[10] The lack of confidence to be a successful student was perceived less stressful which could be associated with growing interaction among the students and the zeal to succeed academically and professionally. Irrespective of pursuing dentistry in India and abroad,[5] the fear of being unable to cope up with workload was more stressful in preclinical years (BDS 1st and 2nd years) and it declined with progression to clinical years (BDS 3rd and 4th years). With each passing year, students faced stress due to attitude of faculty,[5],[6] but this would be necessary for refinement in clinical training if exercised with caution.

The restriction imposed on students because of rules of dental college generated an impacted as a result they also had less time to relax.[7] Pursuing graduation in dentistry whether from India and abroad[5],[6] resulted in increased competition among peers/classmates which appeared more stressful in preclinical years (BDS 1st and 2nd years) than clinical years (BDS 3rd and 4th years). Less recreational facilities and lack of home atmosphere in hostels generated stress corresponding with earlier literature.[5],[10]

Apart from academic overload, there is substantial pressure in completing clinical case quota allocated to students which produces stress due to shortage of time and unavailability of patients at prescribed time for treatment or examination. Thus, completion of clinical quota was more stressful in final-year students in comparison to students in preclinical years (BDS 1st and 2nd years) which matched with earlier studies.[4],[8],[9]

Students in preclinical years (BDS 1st and 2nd years) encountered difficulty in learning preclinical procedures and lacked precision skills in conducting clinical work and laboratory work, however, students in BDS 3rd and final year experienced less stress which was contrary to preclinical practical training in Western dental schools.[3],[5],[6] Another source of stress was working on patients having poor personal hygiene posing risk of cross-transmission of infectious diseases,[5] however, adhering to universal precautions would substantially reduce the risk.

Noticeable was the congenial learning environment generated by teaching faculty since faculty retention in private institution may be dependent upon student feedback. Students might have faced humiliation in receiving criticism about their work from teaching faculty which was similar to earlier studies.[3],[4],[9]

Irrespective of studying in India and abroad, female students perceived higher stress when compared to male students, with top stressors being fear of failure in examinations, fear of academic grades, insecurity of future, and the fear of catching up the workload.[10] Less stress in male students was observed since they tend to worry less and hesitate in expressing their fear. However, there were exceptions such as stern attitude of faculty toward male students and the differentiation in learning styles pursued for male and female students, which arises because male students prefer a casual approach which differs with female students performing diligently when compared with male students.

Stress perceived in relation to rules and regulations of dental curriculum matched with earlier studies reported in India.[9],[10]


Longitudinal studies should be conducted to assess the long-term impact of stress perceived by dental students.

  Conclusion and Recommendations Top

The stress experienced by students during preclinical training and clinical training necessitates the need to incorporate stress reduction program in dental colleges. Transition from preclinical to clinical training causes stress which can be addressed by identifying students who can serve mentors to mentees. It is believed that students pursuing graduation feel the need of mentor who might be able to relieve their anxiety since mentors have had the first-hand experience of the difficulties faced as a dental student.[11] Therefore, peer mentor program could be useful in relieving the stress perceived by students and periodic changes in dental curriculum can be considered by reviewing feedback obtained from students. Grievance redressal committee involving faculty and students members may help students in coping with stress. Psychological counseling can also be considered in reducing stress felt by students.

Peer-assisted learning, an innovative method, should be proposed where students assisting as peer educators could boost the academic performance. This method has demonstrated in improving communication skills of students and may be deployed in reducing stress.[12]

Ethical clearance

BDC/1180- Dated 12/02/2019.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Campos JA, Jordani PC, Zucoloto ML, Bonafé FS, Maroco J. Burnout in dental students: Effectiveness of different methods. Rev Odontol UNESP 2013;42:324-9.  Back to cited text no. 1
Shetty A, Hegde MN, Narasimhan D, Shetty S. Stress and burnout assessment among postgraduate dental students. NUJHS 2015;5:31-6.  Back to cited text no. 2
Aseeri NA, Alasmari FS, Alqahtani MA, Alqahtani SA, Togoo RA. Stress among dental students: A cross-sectional study in Saudi Arabia. International Journal of Scientific Study 2018;5:5-10.  Back to cited text no. 3
Sekhon TS, Grewal S, Gambhir RS, Sharma S. Perceived sources of stress among dental college students: An Indian perspective. Eur J Gen Dent 2015;4:121-6.  Back to cited text no. 4
  [Full text]  
Manolova MS, Stefanova VP, Panayotov IV, Romieu G, Belcheva AB, Markova KB, et al. Perceived sources of stress in fifth year dental students--a comparative study. Folia Med (Plovdiv) 2012;54:52-9.  Back to cited text no. 5
Babar MG, Hasan SS, Ooi YJ, Ahmed SI, Wong PS, Ahmed SF, et al. Perceived sources of stress among Malaysian dental students. Int J Med Educ 2015;6:56-61.  Back to cited text no. 6
Pöhlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and health in the clinical period of dental education. Eur J Dent Educ 2005;9:78-84.  Back to cited text no. 7
Naidu RS, Adams JS, Simeon D, Persad S. Sources of stress and psychological disturbance among dental students in the West Indies. J Dent Educ 2002;66:1021-30.  Back to cited text no. 8
Acharya S. Factors affecting stress among Indian dental students. J Dent Educ 2003;67:1140-8.  Back to cited text no. 9
Tangade PS, Mathur A, Gupta R, Chaudhary S. Assessment of stress level among dental school students: An Indian outlook. Dent Res J (Isfahan) 2011;8:95-101.  Back to cited text no. 10
Lopez N, Johnson S, Black N. Does peer mentoring works? Dental students assess its benefits as an adaptive coping strategy. J Dent Educ 2010;74:1197-205.  Back to cited text no. 11
Peets AD, Coderre S, Wright B, Jenkins D, Burak K, Leskosky S, et al. Involvement in teaching improves learning in medical students: a randomized cross-over study. BMC Med Educ 2009;9:55.  Back to cited text no. 12


  [Table 1], [Table 2]


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