Dental students' dropout rates and professional practice adherence among graduates from a public institution

This study presents a quantitative analysis of data related to the dropout rates at the School of Dentistry at Federal University of South Mato Grosso (FAODO-UFMS) and graduates' professional activity, covering the period between its implementation in 1964 until the year 2015. The data obtained were associated with the existing admission system during the period. The graduates' adherence to the professional practice was investigated and the professional practice time of these graduates and of those ones from other Higher Education Institutions (HEI) in the state of South Mato Grosso (MS). A significance level of 5% was adopted. The Unified Selection System (USS) has a strong correlation with Dental School dropout rates at UFMS. There was no statistical difference in the comparison between students who were admitted by nationwide competition (Vestibular), quotas, or through the use of vacant positions. The average time extent of Dentistry's practice has decreased in MS in recent decades, being statistically lower for the UFMS' graduates than for those ones from other HEI (p<0.001). Of the graduates from the years 1971 to 1990, the percentage of those who have been/are in practice for over 30 years reached 71.43%. The dropout rates at FAODO-UFMS increased with the use of USS as an admission system. Both USS and increase in vacancy at FAODO-UFMS did not show favorable results when related to adherence to the course. The average time of practice for Dentistry in MS has been decreasing, especially for those not graduated from FAODO-UFMS. Descriptors: Dropout. Education, Higher. Professional Practice. Dental students' dropout rates and professional practice adherence among graduates from a public institution Revista da ABENO • 21(1):1111, 2021 – DOI: 10.30979/rev.abeno.v21i1.1111 2


INTRODUCTION
Dropout rates in higher education have been increasing 1,2 and this is a matter of worldwide concern 3-7 . The rates vary considering school option, institution, region and country 3,5,6 . In Brazil, data from the Ministry of Education (ME) show this increase: 11.4% of students dropped out of the higher education institution where they were admitted, in 2010 7 ; and in 2014 it reached a level of 49% 8 . In 2018, of the approximately two million and six hundred thousand students enrolled in public universities, around 204.000 had gone on a leave of absence (7.04%) and 324 thousand had asked to be released from the course (12.4%). In private institutions, these numbers were more significant, with approximately nine million, four hundred thousand students, of which around one million requested a leave of absence (11.7%) and one million eight hundred thousand students had withdrawn from the course (20.76%) 9 .
The studies point to a multifactorial motivation for high dropout rates at HEI, involving the student and/or the educational institution 8,[10][11][12] . The association of the selective process for admission and the dropout rate has drawn some attention 13 . Higher education's selection model varies within the same country or among countries 3,5,11,14 : many are unified, [16][17][18][19] although with different levels of difficulty.
In Brazil, the almost exclusive modality used for admission into Higher Education Institutions (HEI) was the Vestibular exam, until the decade of 2010, when new modalities were introduced. The National High School Exam (NHSE), established in 1998 20 , initially proposed to identify students' performance in specific areas of knowledge, started having other applications, such as being used as a criterion for admission at HEI. The Unified Selection System (USS), implemented by the ME in 2010 21 , allowed the candidate who took the NHSE to apply to different universities that adopt it and choose different courses based on the possibilities available with their scores. In the early 2000s the Law of Directives and Bases to Education (LDB) was approved. It proposes that vacancies determined by student evasion be filled by academics from other institutions by selection process, which has been implemented at UFMS since 2008. Law N. 12711 of August 29, 2012 23 established that federal universities should allocate quotas of up to 50% of their student body to students from the public network education system, thus constituting a reserve for this group of students and, later, to low-income candidates, blacks, browns and native Brazilians. At FAODO-UFMS in 2013, 12.5% of the vacancies were offered to the quota system; 25% in 2014; 37.5% in 2015; and finally, 50% from 2016 onwards.
In the past, with Vestibular as the admission process, the main factors related to dropout rates were approval in another HEI and/or school and failure 24 . It is necessary to investigate the extent to which these new admission modalities reflect on higher education adherence, as being far from one's family and the financial and emotional impact of this distance have already been associated with dropout 3,6,25 .
The knowledge about the indexes and factors that determine the dropout rates in higher education may help in the search for alternatives to predict and prevent it since it is an issue that has an impact on the individual, overwhelmed by feelings of frustration; on their families, which have expectations and provide financial support 6 ; on the labor market, which has become overloaded with investment on human resources' qualification 3,4 and on society, penalized by the reduction in qualified human resources 6 . These issues reflect and interfere with economic growth 6 .
Dental practice requires skills that some candidates do not consider by the time they apply for higher education, and that may contribute to one's inability to perform, such as manual motor skills 26 . There is also the implicit high financial cost, which is a reality regardless of the educational system, public or private, and the unrealistic expectations regarding professional remuneration. These issues may contribute to dropout rates or professional dissatisfaction, resulting in unmotivated and/or insufficient practice 27 and, finally, leading to the abandonment of the practice 26 . This study aimed to identify the dropout rates at FAODO-UFMS from 1964 to 2015 and to verify the professional activity of graduates from FAODO-UFMS from 1971 to 2015.

MATERIAL AND METHODS
This is a quantitative, analytical, timeseries study carried out in the city of Campo Grande, from 2018 to 2020.
The data related to students' admission and graduation from FAODO-UFMS since it started in 1964 up to 2005, were obtained from the academic secretariat of the FAODO-UFMS. The data related to the years after 2005 were provided by the Academic Issues Office (AIO).
The percentage of graduates per class was identified by the list of admitted students who graduated, even if the time required to finish the program was longer than the pre-established one. Dropout was identified as the failure to graduate. Compulsorily transferred students were excluded, either due to dismissal or nonattendance, after the first enrollment. The applicants were divided into groups, considering the admission process: Vestibular, USS, Quotas, and Use of Vacancies.
An analysis was carried out to identify the rate of adherence of the FAODO-UFMS' graduates to the professional practice from 1971 to 2015. The list of graduates was compared with data from the Dentistry Regional Council of MS (DRC-MS) in to identify the activity or dismissal, and with data obtained from the Federal Council of Dentistry (FCD) to locate those who were registered in other states. An investigation was carried out in search engines to identify cases of registration not found in the different Regional Councils or in the Federal Council. The data from the graduates from other HEIs, which were registered in the DRC-MS were also analyzed. A correlation between professional practice time of UFMS' graduates with those of other HEIs' was carried out. An analysis of professional practice time of UFMS' graduates was performed in decades, between 1971 and 2018 to investigate for how long those who were graduated in a determined period have worked (up to 9 years; up to 20 years; up to 29 years and more than 30 years) was done.
The Student's t-test was used to compare different admission processes concerning the average dropout rates; and between the FAODO-UFMS versus other institutions, regarding the years of practice. The comparative analysis of the percentage of undergraduate students admitted through Vestibular, quota holders, and those who filled the vacant positions was performed through one-way ANOVA test. The identification of the adherence rate of Dentistry graduates from FAODO-UFMS to the professional practice in MS or in other states was carried through one-way ANOVA test, followed by Tukey's post-test, as well as the comparison between the length of professional practice time of the graduates from the different HEI in decades and the identification of the average length of professional practice time among those who stopped working in the area. The chi-square test performed the verification of the association between the decade when graduated students from FAODO-UFMS and the range of practice time. The statistical analysis was performed using the statistical program SigmaPlot, version 12.5, considering a significance level of 5%.
This study was approved by the Research Ethics Committee of UFMS, CAAE, Report N. 2.598.529.

RESULTS
In the FAODO-UFMS, the number of annual vacancies was 32 since 1964, with an expansion to 40 seats per year in 1999 and to 50 in 2011. For those admitted through Vestibular, between 1964 and 2010, the average relative dropout was significantly lower than between 2011-2015, when the admission was through USS (figure 1). Figure 2 shows the percentages of students selected by Vestibular (74.123±5.698), by Quotas (60.798±5.564) and by filling vacant positions (60.931±9.076) who graduated, and no significant difference was found when comparing them (one-way ANOVA test, p= 0.353). FAODO-UFMS graduates' adherence to professional practice has shown to be high (93%), since they started entering the labor market, showing a growing percentage of up to 100%, in 1998, when a decline was identified between 1998 and 2008; afterward, the percentage started increasing once more (figure 3).
The average time of practice among FAODO-UFMS graduates was longer than that of graduates from other HEI in all analyzed periods (figure 4), and the difference was always significant (Student's t-test, p<0.001). Figure 5 shows the percentage of professionals who worked for at least 29 years in the decades between 1971-1980 and 1981-1990. As to the relation between graduation date of UFMS' graduates and time of practice in decades, from the 127 graduates between 1971 and 1980, 3.94% of them remained in practice for one decade; 8.66% for one-two decades; 17.32% for two-three decades and 70.08% for more than three decades. Between 1981 and 1990, from the 259 graduates 5.40% remained in practice for one decade, 4.63% for one-two decades, 18.54% for two-three decades and 71.43% for more than three decades. Between 1991 and 2000 from the 239 graduates 6.22% remained in practice for one decade and 9.20% for one-two decades. There was no significant association between the maximum time of practice in decades and the period of graduation, from 1971 to 2000.

DISCUSSION
This study shows that there was a significant increase in dropout rates from FAODO-UFMS when using the USS selection method. Regarding professional practice, it was identified that the adherence of FAODO-UFMS graduates to Dentistry's professional practice is high, and this index decreased in the period between 1998 and 2008, when it started to increase once more. It was shown that the time of professional practice for Dentistry has decreased in the state in recent decades, especially among those who graduated from other HEIs, rather than FAODO-UFMS.
Dropping out may include various concepts, including taking a leave of absence, abandoning the university and abandoning the educational system 1,2,3,10,13 . The analysis of dropout rates using the apparent cohort method 28 , which compares the number of graduates with the number of students admitted to the HEI, may reveal inconsistent results, making it possible to observe course completion rates above 100%, when not all those who graduated from a given course attended school regularly, leading to a higher number of graduates than admitted students in certain classes. To minimize this bias, in this study, the dropout rate was calculated using the identification of students who graduated, even if it took them longer than the regularly envisaged.
There is a diversity of school dropout factors, which also vary from one course to another, between institutions, from one region of the country to another, between countries and considering their historical context, because it has long been investigated 1,2,5,6,10,11,25,28-33 . Among the factors related to the student, we can 70,08 71,43

Graduation decade
Dental students' dropout rates and professional practice adherence among graduates from a public institution  34 ; from those that are circumstantial and individual, such as grades, commitment and feelings of personal adequacy 3 . Among the factors related to the institution, the structure, such as laboratories, services, classrooms, equipment and library, the existence of financial support, such as student's scholarships and loans 3 and the quality of the faculty 29 should be highlighted. The student's educational background and that of the teachers' are reflected in the learning environment of the student group 30 . The number of classes influences the teachers' performance 30 , which reflects on the student's stimulus. The social environment of the university influences the student 31 . However, the system of admission to higher education has received less attention and divergent views regarding the impact on dropout rates; when previously presented results did not identify this factor as related to dropout rates 24 , other studies pointed them out as being inextricably related to them 13,35 . The statistical significance of dropout results found in this study during the period when the USS system was adopted, compared to the period when the Vestibular was used, demonstrates the strong correlation of dropout with the admission system for FAODO-UFMS, as previously observed in other studies 11,13,36 . The implementation of USS coincided with the increase in the number of students at FAODO-UFMS class, two policies that did not show favorable results in terms of adherence to the course when considering the results of this study. The USS is a system that allows students from all over the country to apply to any course for which the score obtained in the NHSE is deemed suficient. The student's sense of inadequacy for the chosen course and the distance between the chosen HEI and the student's place of origin may result in emotional and financial impact that are already related to dropout 3,6,25 .
It was also observed that although the dropout rate among quota holders and students filling vacant positions was greater than that of students admitted through the nationwide competition (Vestibular), this was not statistically significant. However, it has already been considered that, although quota holders value the opportunity, the institution and the course, these students have difficulties in making progress in the academic universe 11 .
Dropout "itself" is considered to be negative for the above mentioned reasons. However, Vries 32 , who analyzes Engineering schools, which show high dropout rates, considered that this issue should be further studied. Individuals who abandon one course may enter another or the labor market, eventually ending up having more professional success than those who completed the course. Nevertheless, dropout has been occurring in courses where, traditionally, this rate was low 7,9 ; it has become a worldwide and growing phenomenon, which should be analyzed, aiming to have information to support the training that generates satisfaction for future professionals, meeting social and labor market demands. It is fundamental to approximate these sectors so that concrete objectives for higher education can be established, based on consolidated data.
Obtaining the secondary data related to graduates' professional practice from the DRC-MS has shown to be a challenge. Some DRC-MS registration data were compromised due to damages apparently caused by humidity. Some graduates who registered with the DRC-MS as well as in other states did not leave this information in their files. In other cases, some inconsistencies were identified regarding the data recorded in the files: duplicate, or even triplicate records, as a result of the reactivation of inactive registrations. Some graduates were not listed as registered, but were identified as active in search engines, which was finally confirmed by the FCD. Some professionals are seen as active in search engines but have no registration with the DRC-MS or are not identified by the FCD. Some Regional Councils have not returned requests for information regarding the activity of professionals they have registered, such as the DRC of São Paulo and the one of Rio de Janeiro.
The implementation of the Regional and Federal Councils of Dentistry was defined by Law N. 4.324, of April 14, 1964 37 , but the Dentistry Regional Council of Mato Grosso (DRC-MT) was created in 1971, following the regulation of Decree N. 68.704, of June 3, 1971 38 and that of MS was created on January 1, 1978, after the division of the state into two. Those who graduated from FAODO-UFMS between 1968 and 1971 were registered in the DRC-MT in that last year and, after the division into two states, the registrations of those who were practicing in the new state of MS were kept and those who graduated after that date were welcomed.
In relation to the practice of Dentistry, the data obtained reveal a decrease in the average time of practice in the most recent period, which is even more significant among the graduates from other HEIs who work in the state of MS. The correlation between the number of professionals and time of practice did not show any statistical difference, but there is an increase in the percentage of professionals working for a short period over the decades. The reasons that determine this behavior encourage future studies.
A limitation of this study is the number of graduates in recent decades, which may have influenced the results regarding the correlation between the number of graduates and time of practice, compared to the previous decades. This is a temporal issue that cannot be controlled by the study design. This limitation may be overcome in future studies, when the number of graduates will allow further investigations. Moreover, for the next proposals related to study object, mixed methodological designs (triangulation of methods) are suggested. This is necessary to expand the understanding of individual and contextual issues inherent to admission systems and affirmative actions, which include procedural aspects and not only results such as student performance. These characteristics practically demand the implementation of qualitative methodological strategies, which may clarify subjective aspects of quantitative studies' objective contributions. When considering the potentialities of different methods, answers that are more robust are visualized on the impact of relevant questions that greatly affect the lives of students and teachers and the university context.
The analysis of the behavior of the graduates from FAODO-UFMS in the labor market, presented in this study, is unprecedented in the literature and precious for those who are interested in applying to the course. In this context, one might consider what Vries pondered in 2011 32 , when he pointed out that higher education dropout may not be an unfavorable event. The students may turn out to be more successful professionally or more satisfied with the practice of another professional activity before many years of their life have been spent until they reassess their initial choice or professional frustration leads them to reflect upon that. Moreover, there have been changes in dental practice paradigms, such as the model of care in private practice being replaced by care in public health promotion environments 39 . In these locals, theoretical and methodological bases are created by the best scientific evidence, together with the possibility of generating a greater social impact, since its goal is the health-disease process in human collectivities. These issues encourage new investigations that bring subsidies to define new directions for education in Dentistry.

CONCLUSIONS
The use of USS as an admission system showed a strong correlation with dropout rates at the FAODO-UFMS during the analyzed period. Both USS and increase in vacancy at FAODO-UFMS did not show favorable results when related to adherence to the course. The average time of professional practice in Dentistry has decreased in recent decades, especially for the graduates from other HEIs, other than FAODO-UFMS.

ACKNOWLEDGEMENTS
This study was supported by the UFMS.