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Who you are and who you want to be: a pilot study of dental hygiene students' professional identity formation

BMC Medical Education volume 24, Article number: 1035 (2024) Cite this article

Abstract

Background

Dental hygienists play a crucial role in providing successful community-based healthcare for patients. They should perform expected roles to address various tasks, in response to changing social contexts and needs. The value created by the role of a dental hygienist closely relates to job satisfaction, which is formed through daily clinical experiences, and in the process of professional identity formation, learners must internalise a value system. This study examined how dental hygiene students developed their professional identities during their undergraduate education.

Methods

This study adopted a case study approach based on an interpretivist paradigm. Ten dental hygiene students in their final year were selected, and semi-structured interviews were conducted regarding changes in their views on dental hygienists and their identities as health professionals. The data were analysed using a thematic analysis approach to identify the components of their professional identities and the factors influencing identity formation.

Results

Students pre-professional identities were transformed into inter-professional collaborators with a more patient-centric and generalist perspective. The following three aspects of professional identity were identified: their own roles in promoting oral and general health, broadening the perspectives on professional competencies of dental hygienists, and the context of inter-professional collaborative practice. Additionally, this study identified some key factors influencing their identity formation, namely role models, clinical experiences, health care system, and social relationships with others. Among these factors, role models and clinical experiences were the most influential.

Conclusions

This study suggests that recognition of professional roles during preclinical education, and collaborative opportunities in clinical education are necessary to promote professional identity formation. Such learning opportunities enable students to reflect on the kind of dental hygienist they want to become. Moreover, for the students to continuously pursue their profession with a sense of fulfilment, educators need to gain a deeper understanding of the challenges the students would encounter as they transition from their undergraduate degrees to employment. This understanding is essential for developing and supporting communities where dental hygienists connect, help, and learn from each other.

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Background

Dental hygienists are recognised as essential health care professionals who contribute to oral health [1]. Since oral health is closely related to general health and quality of life [2,3,4,5,6], dental hygienists’ scope of practice are expanding, particularly in North America and Europe [7]. For example, dental hygienists are expected to collaborate effectively with other professionals in the fields of medical and social services [8]. This is partly because an aging population has led to an increase in the social demand for community-based care for the elderly, where dental hygienists need to be engaged as essential health care professionals [9,10,11]. They play various roles depending on the local health care system and social expectations, including the role of clinical practitioners, health educators, health promoters, managers, and researchers [12]. In response to changing social contexts and needs within the health and welfare field, dental hygienist roles may include perioperative oral hygiene management, oral function management to prevent disease, and smoking cessation guidance [7, 8]. Therefore, dental hygiene undergraduate education should be further enhanced to include, the expanding range of responsibilities [8, 13, 14].

Japan has one of the fastest-aging societies in the world [15]. Dental hygienists play a pivotal role in providing successful community-based healthcare services, including home visit care and preventive dentistry for patients at all life stages [12, 16, 17]. Although the number of newly hired dental hygienists is increasing in Japan, qualified dental hygienists are not keeping up with the expectations of societal needs and health care facilities [16,17,18,19]. According to two surveys conducted in 2020, the employment rate of licensed dental hygienists was less about 50% [20, 21], and many dental hygienists left the profession. Such a high turnover rate has become problematic for Japan, resulting in a shortage of dental hygienists.

Although high job satisfaction among dental hygienists has been reported in Western countries, they also face adverse experiences that may lead to high turnover and burnout. These experiences include musculoskeletal pain, difficulty maintaining a work–life balance, long work hours, working without assistance, and dealing with difficult patients [22].

Job satisfaction is directly associated with turnover intentions among health care professionals [23,24,25]. According to Ohara and Nomura, dental hygienists perceived that their national qualification ensures stable employment and compensation as an attractive feature of dental hygiene work [26, 27]. However, ‘values’ such as contribution to society and people, individuality, and high professional work were more closely associated with job satisfaction [28]. Dental hygienists who recognise ‘service and social contribution’ as important values and motivation to work expressed a clearer intention to continue their careers [29]. Therefore, dental hygienists' professional values were embedded in job motivation and continuity [28]. In other words, besides environmental factors such as life events and workplace benefits, psychosocial factors such as dental hygienists' own sense of value toward their professional work also influence turnover rates.

A set of professional values is regarded as an attribute of professionalism, which refers to the possession and demonstration of the socially expected conduct and attitudes of a professional, while professional identity refers to how an individual perceives themselves as a professional. Therefore, professional identity formation is underpinned by the teaching of professionalism [30]. The value systems are formed through daily clinical experiences, which is the core element of professional identity formation [31]. In the process of professional identity formation, the learner must internalise value systems, including norms, roles, expectations, ideas, and behaviours associated with the medical profession [30], in addition to knowledge and skill acquisition.

Re-examining existing identities, which involves internalising new values and altering practices and behaviours, can be challenging, and the individual requires the support of those around them during this process [32]. As professional identity formation is influenced by ‘role models’, [33, 34] ‘mentors’, [33, 35]’personal experiential learning’, [33,34,35] ‘patient encounters’, [33, 34] and ‘social expectations’, [33,34,35] constructing meaning from these personal events and interactions with others may alter the course of professional identity formation [34, 36]. Successful professional identity formation leads to a successful career, while the mismatch between an individual’s internal orientation and their professional role creates anxiety, frustration, and a sense of inadequacy, sometimes leading the individual to leave the profession [32].

According to Nagatani et al., dental hygienists' educational background, clinical experience, and social interactions with medical and dental healthcare professionals and patients in the medical and dental field shape their perceptions of professionalism [37]. Although some cross-sectional studies have examined the formation of professional identities in dental hygiene students and dental hygienists in the US and European countries [38, 39], there is limited research on this issue in the context of Asian countries. As professional values are naturally influenced by culture, it is important to examine various cases in different cultural contexts [38, 39]. However, the internalisation process of dental hygiene students' values and norms toward their profession has not been fully investigated. Therefore, as a preliminary investigation of dental hygienists’ professional identity formation, this study aims to explore the professional identity formation process of dental hygiene students over their undergraduate education. Specifically, the following research questions were developed:

(1) What professional values have dental hygiene students developed as a part of the professional identity formation process?

(2) What factors influence the formation of a dental hygiene student's professional identity?

Theoretical framework used in this study

The process of professional identity formation and influencing factors

This study adopted the model by Cruess et al. that influences the socialisation process of physician identity formation [33]. Socialisation is the process by which a person internalises the values and norms of a particular society or group and learns to function within it, and is a key process through which identity is developed [30]. Their framework includes the following ten factors: learning environment; health care system; isolation from peers; family and friends; role models and mentors; clinical/non-clinical experiences; formal teaching and assessment; self-assessment; symbols and rituals; and attitude of/treatment by patients, peers, health care professionals, public [33]. The most influential factors are considered to be ‘role models and mentors’ and ‘clinical/non-clinical experiences’.

Constitutive concepts of post-socialisation professional identity

This study drew on ‘the three constitutive concepts of identity’ classified by Rasmussen et al. Their study identified three themes within the concept of professional identity: role (the responsibilities and social role of the nurse), self (job adaptation, job satisfaction, contribution to self-esteem, sense of belonging), and context (awareness of context) [40]. The strong alignment among these three categories leads nursing staff to enhanced satisfaction with the professional role, increased staff retention, and improved quality of patient care and outcome [40]. Both nurses and dental hygienists are health professionals who assist doctors and dentists in their practice and support patient health. The constitutive concepts of identity [40] can be applied to other health professional contexts, including dental hygienist’ professional identity formation.

Methods

Study context

Japan has 183 dental hygiene training schools, including four-year universities, three-year junior colleges, and vocational schools. The educational contents in all training schools are in accordance with the Dental Hygiene Education Core Curriculum issued by The Japan Association for Dental Hygienist Education in 2018. As a part of their undergraduate course, the dental hygiene students should acquire the following: “the ability to make judgments based on evidence-based medicine,” “responsiveness to the sophistication of medical care and changes in the social context,” “collaboration with multiple professions,” “broad insight and rich humanity,” “high ethical standards,” and “lifelong learning ability” [41].

This study was conducted at a three-year junior college in a regional city in Japan, where first-year students attend lectures on liberal arts, basic dental specialties, and dental hygiene. In their second year, the students attend lectures on specialized clinical subjects and the dental hygiene practice through practical training using mannequins and in-campus training. Moreover, they have the option to learn about the support of medical care welfare clients and the well-being of their clients from the second semester of their first year to the first semester of their second year. These curricula are present as part of segmented subjects, not integrated learning. Furthermore, the students are exposed to patient care in dental clinics and oral surgery departments of general hospitals, nursing homes, and disability support facilities during their third year.

Data collection

This study adopted a case study approach based on an interpretivist paradigm to conduct a detailed analysis of the professional identity formation of dental hygiene students. Yin [42] defines the case study research method as an empirical inquiry that investigates a contemporary phenomenon within its real-life context. Case studies are a useful approach where the focus is to explain the complexities of real-life situations [42, 43]. The research focus of this qualitative study was specifically on the professional identity formation of dental hygiene students in the context of a single dental hygiene school in Japan.

A convenience sample of 10 dental hygiene students (A-J) who were in their final year of a three-year program at a junior college of dental hygiene were recruited for this study.

Participation in this study was voluntary. Participants were assured of the confidentiality of the data collected in this study and were informed that they could withdraw from the study at any time without negative consequences, such as an impact on their academic standing.

All participants were females between the ages of 21 and 22 years who had completed their clinical training course. As students who had graduated from secondary schools and enrolled in dental hygiene school in 2019, they had no prior higher education or clinical experience as health care professionals. Therefore, the qualitative data elicited from the participants allowed the researchers to make an in-depth analysis and thick description of how their learning experiences within a dental hygiene college curriculum have influenced their professional identity formation.

After clinical placements, including training in dental hospitals and clinics, semi-structured interviews were conducted in the researcher's laboratory in January and February 2022. The interviews lasted between 22 and 63 min. The interviews were audio-recorded with consent obtained from the participants. During the interviews, the participants were asked to share their views of dental hygienists as health professionals in terms of professional identity formation. Moreover, to gain a deeper understanding of the process of identity formation, factors that shaped their views were also explored. Specifically, participants were asked to share their detailed experiences in relation to identity formation from when they first thought of becoming a dental hygienist to the present. The interview schedule was developed based on a previous study concerning professional identity formation with medical students [44]. The following questions were asked of the dental hygiene student:

  1. (1)

    What inspired you to become a dental hygienist?

    • Why did you choose dental hygiene as a career?

    • What characteristics of a dental hygienist would you want to possess?

  2. (2)

    What roles and responsibilities do you think are socially expected of dental hygienists?

    • Among those roles and responsibilities, which one do you think is more important? Why?

  3. (3)

    What aspects do you think you should improve to fulfil those roles and responsibilities of dental hygienists?

  4. (4)

    What events in the past three years have influenced your perception of dental hygienists and professionalism (campus activities, clinical practice, social activities, people you have met, etc.)?

  5. (5)

    What kind of education and support would you have liked to receive from your teachers to become a dental hygienist?

During the conversation, using probing questions, the researchers gathered as much information related to the study’s aims as possible. The semi-structured interviews allowed them to elicit richer data on dental hygiene students' perceptions of professional values that are fundamental to professional identity formation.

This study was approved by the Institutional Review Boards at University of Shizuoka (No. 1–19: Approved on December 7, 2021) and Gifu University (No. 2021-B175: Approved on January 17, 2022). Informed consent was obtained from all participants. All methods were carried out in accordance with the Declaration of Helsinki.

Data analysis

The audio recordings of the interviews were transcribed and analysed using a thematic analysis approach to extract the components of the dental hygiene students' professional identity and the factors influencing their professional identity formation. Thematic analysis is one of the most flexible methods of qualitative research analysis [45]. Thematic analysis reflects the researcher's position, seeking meaningful patterns in the data and identifying themes through a process called reflexivity. It allows researchers with diverse methodological backgrounds to participate in the analysis.

First, the first author systematically reviewed the transcribed data to gain a better understanding of its content. Then, the text data were divided into small units and classified as meanings, actions, events, or ideas from what the participants had experienced and thought over the three years. Each of these small units was then labelled with an interpretive description. The labels related to professional identitywere integrated based on the three constitutive concepts of identity (i.e., role, self, and context) by Rasmussen et al. [40], and labels related to factors influencing their professional identity were categorised with reference to the model by Cruess et al. [33] which includes the following ten factors: learning environment; health care system; isolation from peers; family and friends; role models and mentors; clinical/non-clinical experiences; formal teaching and assessment; self-assessment; symbols and rituals; and attitude of/treatment by patients, peers, health care professionals, public [33].

Subsequently, all researchers compared the results of individual initial coding and identified significant broader patterns of meaning to identify main themes regarding their professional identity formation. All researchers then reviewed the initial themes iteratively to ensure that their interpretations were congruent with the presented data. To define the final themes, the researchers conducted a detailed analysis, determined the focus, and established the narrative for each theme [46, 47]. Finally, the researchers contextualised the analysis of the existing literature. The Standards for Reporting Qualitative Research were used for writing the report [48].

To enhance the credibility of this qualitative study, three of the researchers (YN, RI, and KH) cross-checked their data interpretation and analysis following the first author’s initial analysis. The preliminary findings of the analysis were carefully reviewed multiple times by all the members of the research team, including RI, KH, YS, and TS, to establish the validity of the data analysis. Theoretical saturation was achieved on the basis of the authors’ agreement after analysing the interview data of the 10th participant.

Results

Overview of the dental hygiene students’ professional identity formation processes

By qualitatively analysing dental hygiene students’ reflections on their learning experiences, this study conceptualised their professional identity formation processes throughout their undergraduate education (Fig. 1). Their pre-professional identities (pre-professional identity as a less mature version of professional identity [49]) were transformed into inter-professional collaborators with a more patient-centric and generalist perspective, instead of just focusing on oral health. Additionally, this study found the following key factors involved in the identity formation process: role models, clinical experiences, health care system, and interaction with clinical personnel and peers. The following sections provide a detailed description of their learning experiences in relation to professional identity formation.

Fig. 1
figure 1

Socialisation of dental hygiene students' identities in transition

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Development of professional value in dental hygiene students

Existing pre-professional value as dental hygienists when starting their education

This study investigated how the participants’ professional values and perceptions of dental hygienists (called pre-professional identity) transformed during their 3-year undergraduate education.

Pre-professional identity includes their motivation for becoming dental hygienists and perceptions of the profession before entering school. Based on the conceptual analysis of professional identities by Rassmussen et al. [40], three key aspects of dental hygiene students’ pre-professional identities were identified: professionals who protect the teeth, kind person working in dental clinics, and determinants of career selection. Table 1 provides verbatim examples of the key aspects (i.e., the role, the self, and the context).

Table 1 Existing dental hygienist pre-professional identities
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As to the role, the participants recognised their responsibility and social role as preventive professionals who protect teeth from oral disease. In most cases, they portrayed themselves as professionals who provide oral health care management services, such as tooth brushing instructions through patient experiences in dental clinics. Additionally, students were impressed by the friendliness and caring nature of dental hygienists when they visited dental clinic as patients. Their decisions to become dental hygienists were influenced by the belief (the context) that nationally qualified professionals ensure a stable income and reemployment opportunities after leaving the workforce due to marriage and childrearing.

According to the excerpts, dental hygiene students placed more importance on careers that require less psychological and physical burden than other medical professions, such as nurses. Specifically, students perceived that dental hygienists do not work with patients in serious conditions, and do not work night shifts (Table 1).

Professional values as dental hygienists developed through undergraduate education

Underpinned by the model proposed by Rassmussen et al. (i.e., the role, the self, and the context), the following key aspects of professional values were developed among dental hygiene students who completed clinical placements: their own roles in promoting oral and general health, broadening the perspectives on professional competencies of dental hygienists, and the context of inter-professional collaborative practice. Table 2 presents verbatim examples of each subtheme.

Table 2 Professional values as dental hygienists developed through undergraduate education
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The dental hygiene students recognised that the roles of the dental hygienist involve promoting the prevention of oral diseases and general health by providing treatment and instructions to patients. In order to perform these roles, they believed their own competencies necessary for dental hygiene practice should include not only knowledge and skills, but also values and social skills, such as honesty and relationship building with patients. Their broadened perspectives on the roles and the self were developed through experiences in the context of clinical education. In particular, dental hygienists who served as their supervisors actively engaged in interprofessional care, such as confidently sharing their opinions and experiences based on medical and oral knowledge with nurses. Moreover, they noted that in dental practice, dental hygienists are expected to act as a bridge between patients and dentists, which is pivotal to effective dental treatment. Their awareness was increased through the active engagement in comprehensive patient care within an interprofessional team, where their oral care skills needed to be displayed. However, some students expressed uncertainty about the professional values of dental hygiene or had difficulty explaining the specific components of dental hygienists’ professionalism.

The student participants emphasised that dental hygienists should possess expert knowledge, skills, and a strong sense of responsibility in oral health to provide the appropriate treatment and instructions to solve clinical problems. Moreover, the participants recognised the importance of promoting patients’ behavioural changes regarding oral health based on a better understanding of patients’ psychosocial backgrounds. Working together with dental hygienists, whom they viewed as role models, allowed them to have positive expectations and a clearer vision for their own future after employment.

Additionally, the participants being emersed in a dental hygiene practice broadened their understanding of the clinical context from a mere dental practice field to an inter-professional collaborative practice. Participants emphasised the importance of building non-hierarchical relationships with other health professionals and developing expertise in oral care within the clinical context to provide effective patient care and treatment. Moreover, they recognised the importance of collaborating with dentists for smooth dental treatment (Table 2).

Factors influencing professional identity formation of dental hygiene students

Employing Cruess et al.’s framework of the socialisation process of medical students [33], this study identified six themes regarding the key factors that influence professional identity formation among dental hygiene students. The following sections provide a detailed description of each theme.

Role models

Encounters with role models play a crucial role in the identity formation process. By observing a role models’ performance, including clinical intervention and decision-making the participants received a better understanding of what it is like to be a dental hygienist. Moreover, the participants enhanced their understanding of dental hygienists’ role as essential health professionals who are responsible for oral health care in an inter-professional team by observing role models’ relationship-building with other medical professionals. Given this context, the feedback and direct coaching from such role models were impactful and highly motivated the participants. Table 3 presents the verbatim examples of each sub-theme.

Table 3 Role models
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Clinical experiences

The student participants were first exposed to clinical practice during the clinical placement in their third year of study. During the program, they learned about the daily flow of their duties at dental clinics and hospitals, as well as specific dental hygiene procedures. Moreover, they gained a better understanding of real patient care, specifically in a severe life-and-death situation in hospital oral surgery, the responsibilities of their own profession, and ways of making timely clinical decisions through social interactions with medical professionals and patients. Despite the participants’ initial concerns about dealing with patient problems on their own, they tried to participate in the clinical practice by considering their patient’s situation. Table 4 presents verbatim examples of each sub-theme.

Table 4 Clinical experiences
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Health care system

Social context influences people’s behaviour and thinking [50]. In this study, the participants observed that health care systems influence and regulate oral care practices. Specifically, they observed that many dental clinics comprised only oral professionals and provided simple oral-only treatments. The Japanese National Insurance System regulates the payment of dental service fees on a piecework payment basis. Moreover, the student was faced with a dilemma due to the limited amount of time allocated to each patient in the dental clinic, and her desire to deliberately provide patient-tailored care. Table 5 presents the verbatim examples of each sub-theme.

Table 5 Health care system
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Interaction with clinical personnel and peers

Social interactions with people in the clinical contexts influence oral health care professionals’ self-esteem. Encouragement and appreciation from patients and peers positively influenced students’ professional identity formation. Particularly, their identities developed as a result of overcoming challenges encountered in clinical practice by building supportive relationships among peers. Moreover, taking breaks together with clinical staff made them feel part of the oral health care team. However, in terms of inter-professional care, dental hygienists felt inferior to other medical professionals due to their limited knowledge of general health and care, resulting in their belief that they could not contribute substantially to medical care. Similarly, they felt that they had a hierarchical relationship with the dentist existed, since dental hygienists in Japan are expected to perform their duties as per the dentist’s instructions. Table 6 presents verbatim excerpts of each sub-theme.

Table 6 Interaction with clinical personnel and peers
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Discussion

This study examined the development of professional identity among dental hygiene students throughout their undergraduate education. The results of this study have significant implications regarding the identity development of dental hygienists, which require attention, to develop dental hygienists who are more responsive to society's needs. This study has provided new insight into how dental hygiene students internalised their own professional values, suggesting that their identity was situated in the educational context and shaped by their perceptions of learning experiences. This finding is supported by previous studies [33] which underscore the importance of educational development in promoting successful identity formation in dental hygienists. The professional identities of the students in this study have transformed from simple member of dental team into member of clinical team, emphasise the importance of inter-professional collaboration based on their understanding of professional roles in society. Furthermore, they gained a greater understanding of the competencies required to fulfil the recognised roles of dental hygienists.

A better understanding of the roles and responsibilities of dental hygienists helped to form their professional identity. Clinical experiences such as providing patients with oral health instructions to avoid future lifestyle-related including, dental caries helped the students realise that dental hygienists are not only an integral part of dental care, but part of a medical-dental collaborative care team (Theme 4–1) [14, 51].

In an aging society, dental hygienists are expected to provide oral health care to individuals at all stages of life [16, 17]. Dental hygienists are required to follow the instructions by dentists and practice as health care professionals who can work together with patients to solve identified oral health problems [52, 53]. Additionally, the participants recognised the societal expectations of dental hygienists through their clinical practice [14, 34, 54]. Specifically, students encountered situations in which dental hygienists made recommendations on treatment plans and patient care to dentists and recognised the need for dental hygienists to proactively engage in clinical practice and collaborate with dentists (Theme 8–3).

The findings in this study are consistent with previous studies regarding the socialisation of medical students [33], suggesting that role models and clinical experiences are highly influential factors in the formation of professional identity in physicians. By observing role models’ performance personalised treatment and health instruction for each patient during clinical practice, the students perceived that providing the appropriate treatment and oral health instructions to address patients’ problems is a core component of professional identity. Particularly, an image of the ideal dental hygienist such as patient-centred care and flat collaboration with other professions was formed by observing the performance of many dental hygienists in health care facilities, including those who performed patterned tasks such as routine work, and those who demonstrated professional competence for patient-centred medical and dental practice (Theme 7–1, 7–2) [55, 56]. This result is consistent with the results of previous studies involving nurses, in which the instructors’ behaviour and attitude influenced the learners' internalisation of professional values [57].

This study identified facilitating factors in students’ professional identity formation; whereas several students also expressed hindering factors. For example, the professional value of a dental hygienist was exclusively focused on ‘being skilful at cleaning teeth’ and ‘being knowledgeable about oral health’ (Theme 4–3). In other words, participants were unable to find the professional values and roles from a holistic perspective. This may have resulted from the practice system in the dental field, especially in dental clinics. In the current dental care system, the number of patients treated is an important criteria for managing dental clinics and healthcare institutions.　Moreover, dental clinics in Japan employ the piecework payment-based system, which means that managers have a desire to treat as many patients as possible (Theme 10–2). In this context, dental hygienists are urged to complete the dental hygiene procedures and provide care efficiently [19]. Therefore, such learning environments in dental clinics have encouraged the students to focus on improving procedures and dental care skills, such as calculus removal, mechanical tooth cleaning, and oral health instruction. Similar to previous studies in nursing education, the students were too focused on the performance of tasks to understand the significance of each patient’s care and procedure [58]. If students focus too much on performing minor tasks when providing treatment, it becomes difficult for them to form a professional identity [25]. This is because having an awareness of professional values and their role in society, as well as positive perceptions of the profession allow them to internalise the dental hygienist's value system [32].

The reasons for entering dental hygiene schools were related to the formation of professional identity. For example, some students chose the dental hygiene profession based on their requirements, not on their own personal wants and desires, such as considering the advantages of being a nationally qualified professional (Theme 3–1) and perceiving that dental hygienists experience less psychological and physical burden than other professionals (Theme 3–2). These students did not develop a clearer vision of what kind of dental hygienist they wanted to become, and had difficulty forming a specific professional image of a dental hygienist through their undergraduate education. However, previous studies in other health professional fields have demonstrated that students who had entered their schools with strong interests in the profession continued to actively learn throughout their undergraduate education and clinical practice [59, 60]. Therefore, these students lacking readiness to undertake professional learning would be unable to form their professional image and vision for the future, as well as recognise their professional value without the appropriate education and intervention based on their level of readiness.

Dental hygienists need to develop teamwork and communication skills to provide oral health care and treatment in an interprofessional team since patient problems are becoming increasingly complex in the society. As oral health professionals, dental hygienists are expected to engage in lifestyle-related disease prevention, home medical care, and even terminal care for elderly patients to improve their oral hygiene and oral function [61, 62]. However, the participants in this study felt inferior to other professions in the medical field (Theme 11–3), which created barriers to inter-professional collaboration. Specifically, they perceived that dental hygienists had relatively less medical knowledge and skills, and thus would not be able to handle interprofessional collaborations. In other words, they recognised the need to acquire more medical knowledge to achieve inter-professional collaboration [63]. Therefore, effective information sharing and exchange of opinions in inter-professional collaboration are essential to overcoming their feelings of inferiority [64] and increasing learning opportunities. Although dental hygienists believed that they should be able to share their opinions with dentists in the dental field, they found it difficult to express their opinions to healthcare professionals in the medical field. Social groups and relationships differ from culture to culture. Japan is a social group that prioritises ‘place’, emphasising a group consciousness of ‘we’ and strengthening rivalry with similar groups ‘others’. This seems reveals a characteristic of the ‘we’ and ‘others’ collectivism of Japanese culture—one's own home and the outside [65].

Interprofessional education could be introduced during the pre-clinical learning phase to minimise feelings of inferiority towards other professions in the medical field and encourage their perception of an ‘we’ culture that includes the medical field. Some previous studies have reported that students not only improved their teamwork and collaboration skills [66, 67], but also developed positive professional values associated with their own professions [68] through inter-professional education. Additionally, understanding the roles and responsibilities of other health professionals in undergraduate education [69] motivates students to collaborate with others during clinical placement [70, 71].

During the clinical placement program, the participants supported each other to overcome challenges, and cope with situations in which they needed to take initiatives in the clinical practice (Theme 12–2). In other words, developing a peer-learning community is essential to the formation of professional identity. According to a previous study, connections among peers in the same professional field play an important role in overcoming professional difficulties [72]. However, the peer learning community formed during undergraduate education mostly ceases when students graduate and enter the workplace as dental hygienists, where they meet less and less on a daily basis. Since approximately 90% of dental hygienists in Japan work in dental clinics serving small communities [21], social relationships between dental hygienists in other workplaces, such as study groups and professional associations, are relatively weak or even non-existent. Therefore, the educators should pay more attention to the transition period between undergraduate education and entry-level clinical practice to support learners’ professional identity formation, such as by promoting the formation of peer-learning communities [73,74,75]. It is necessary to form a peer learning community where dental hygienists can continue to learn from each other after commencing employment.

In case of the professional learning community, there is a need for an organisation that will provide connections after leaving the profession, training support for returning to work, and stress management and counselling during employment [76, 77]. For example, a nationwide organisation, such as the Japan Dental Hygienists' Association, is expected to function as a community where dental hygienists can connect, help, and learn from each other.

Limitations of the study

This qualitative study explored dental hygiene students' professional identity formation throughout their undergraduate education. However, since the data were collected from a small number of participants at a single educational institution, the results were not generalisable. Therefore, for further research, quantitative studies using validated measurement tools of professional identity and empathy, such as MacLeod Clark Professional Identity Scale [78] and Jefferson Scale of Empathy [79], would be needed to examine changes in students’ perceptions of professional identity in larger populations, including universities, other junior colleges and vocational schools. This is because different educational systems and learning contexts might influence students’ perceptions of professional values. A further important issue to be addressed is to explore not only students' own perceptions, but also the perspectives of others, such as educators and fellow students, who support the formation of students' professional identities. In particular, investigating educators’ perspectives can reveal pedagogical implications regarding their roles and responsibilities.

Conclusion

This study revealed the type of professional identities dental hygiene students developed, and the factors involved in the formation process. Particularly, clinical experiences and role models played an important role in shaping their professional identities. Professional identity formation for dental hygienists can be facilitated by recognising the positive perceptions of the profession and the role of dental hygienists in society. Inter-professional education is effective in promoting dental hygiene student recognition. For dental hygienists to continue pursuing their profession with a sense of fulfilment, educators need to understand the challenges that students would encounter while transitioning from undergraduate to employment. There is a need to explore how continuous peer learning communities can be developed among dental hygienists.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We are grateful to the dental hygiene students who willingly participated in this study and shared their experiences with us.

Funding

This work was supported by the JSPS KAKENHI Grant-in-Aid for Young Scientists Number 22 K17279.

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Authors and Affiliations

  1. Department of Dental Hygiene, University of Shizuoka, Junior College, 2-2-1 Oshika, Shizuoka-Shi Suruga-Ku, Shizuoka, 422-8021, Japan

    Yukiko Nagatani

  2. Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan

    Rintaro Imafuku, Kaho Hayakawa, Yasuyuki Suzuki & Takuya Saiki

Authors
  1. Yukiko Nagatani
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  2. Rintaro Imafuku
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  3. Kaho Hayakawa
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  5. Takuya Saiki
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Contributions

YN contributed to the concept and design of the study as a principal investigator. The data collection procedure was conducted by YN. RI, KH, YS and TS were involved in the and the analysis and interpretation of the data with YN. YN and RI wrote the original manuscript and all authors participated in critical revision of the article and approved the final article.

Corresponding author

Correspondence to Yukiko Nagatani.

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Ethics approval and consent to participate

This study was conducted with the approval of the University Institutional Review Board　(No. 1–19: Approved on December 7, 2021) and the Gifu University Institutional Review Board (No. 2021-B175: Approved on January 17, 2022). Informed consent was obtained from all participants. All methods were carried out in accordance with the Declaration of Helsinki.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Nagatani, Y., Imafuku, R., Hayakawa, K. et al. Who you are and who you want to be: a pilot study of dental hygiene students' professional identity formation. BMC Med Educ 24, 1035 (2024). https://doi.org/10.1186/s12909-024-06027-4

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ISSN: 1472-6920

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