Another blog post of personal privilege, or just something I felt like writing. I’m comforted by the fact that no one other than me is likely to read it.
I began dental school at Indiana University in 1975, and little did I know what awaited me.
Dental education in the 1970s was academically punishing and psychologically intense. Students carried extraordinary course loads: 41 credit hours in the first year was typical, and total graduation requirements reached upwards of 160 credit hours. Before I started the year, I assumed, I hope the credit hours were somehow not the same as in undergrad where 15 hours a semester was considered a “full load.”, but they were. The curriculum was front-loaded with anatomy, biochemistry, and dental materials, followed by exhaustive laboratory work and clinical quotas that demanded both intellectual precision and manual skill. Compared with their medical counterparts, dental students faced heavier daily schedules and stricter performance standards. It was widely accepted, even among faculty, that dental school was harder than medical school because it required mastery of both complex science and fine-motor craftsmanship under relentless scrutiny.
The culture of dental education in that era resembled militaristic training. Many faculty members—educated in the 1940s and 1950s—embraced an authoritarian, hierarchy-driven model rooted in the belief that fear and discipline built professional competence. Public questioning and humiliation were routine: an incorrect answer in class could prompt a sarcastic rebuke or public embarrassment meant to “toughen” the student. In clinics, instructors sometimes barked commands or criticized work in front of patients and peers. Emotional endurance was viewed as essential as intellectual ability, and failure to maintain composure was seen as weakness. Students were expected to withstand fatigue, humiliation, and relentless evaluation without complaint—the academic equivalent of boot camp.
Research in the following decade confirmed that this environment exacted a psychological toll. Surveys published in the Journal of Dental Education during the 1980s found that dental students experienced higher levels of stress, anxiety, and depression than their medical counterparts. Many cited “constant evaluation, fear of failure, and faculty intimidation” as dominant stressors. Yet, despite its harshness, the system produced highly disciplined clinicians, which partly explains why it persisted for decades.
By the 1990s, educational reformers recognized the cost of that approach. The American Dental Education Association (ADEA) and the Commission on Dental Accreditation (CODA) redefined educational quality to include student well-being and professional respect. Pass/fail and competency-based grading replaced competitive rank-ordering. Simulation laboratories supplanted live-patient humiliation as the arena for skill mastery. Faculty were trained to provide constructive feedback rather than public ridicule. Centralized patient pools removed the anxiety of recruiting one’s own cases. Counseling services, mentorship programs, and wellness initiatives became integral components of the curriculum.
Today, the DDS program at Indiana University requires 170 credit hours, slightly more than in the 1970s but spread across a broader, integrated curriculum encompassing behavioral science, evidence-based practice, and community health. The old militaristic ethos has largely disappeared. Modern students still experience stress—primarily financial, as average dental-school debt now exceeds $300,000—but few encounter the emotional trauma that once characterized professional training.
This transformation marks a profound shift in values: excellence is no longer measured by endurance under fire but by competence fostered through mentorship, empathy, and professionalism. The compassion and psychological safety that define contemporary dental education exist largely because earlier generations endured an abusive teaching environment that proved the need for a better way. Progress has been made albeit too late for generations of earlier dental students.
References and Further Reading
American Medical Association. (2014). Teaching by humiliation: Why it should change. AMA Journal of Ethics, 16(3), 183–188. https://journalofethics.ama-assn.org/article/teaching-humiliation-why-it-should-change/2014-03
— Analyzes the historical use of humiliation as a teaching tool in health professions and argues for reform toward respect-based pedagogy.
Davis, E. L., Tedesco, L. A., & Meier, S. T. (1989). Dental student stress, burnout, and memory. Journal of Dental Education, 53(3), 193–195. https://pubmed.ncbi.nlm.nih.gov/2745836/
— Demonstrates correlations between stress, burnout, and cognitive function among first-year dental students.
Grandy, T. G., Westerman, G. H., & Combs, C. E. (1984). Stress among first-year dental students. Journal of Dental Education, 48(10), 560–562.
— One of the earliest quantitative studies documenting severe stress levels among entering dental students.
Grandy, T. G., Westerman, G. H., Combs, C. E., & Turner, C. H. (1989). Perceptions of stress among third-year dental students. Journal of Dental Education, 53(12), 718–721.
— A longitudinal follow-up showing persistent stress throughout clinical training years.
Heath, J. R., Macfarlane, T. V., & Umar, M. S. (1999). Perceived sources of stress in dental students. British Dental Journal, 186(5), 207–210. https://doi.org/10.1038/sj.bdj.4800058
— Found that dental students reported significantly higher stress than medical students across multiple domains.
Kalet, A., Chou, C. L., & Ellaway, R. H. (2017). To teach is to learn twice: Sensemaking in medical education. Academic Medicine, 92(9), 1222–1224. https://doi.org/10.1097/ACM.0000000000001806
— Describes the persistence of humiliation as a learned tradition in medicine and advocates reflective teaching practices.
Lempp, H., & Seale, C. (2004). The hidden curriculum in undergraduate medical education: Qualitative study of medical students’ perceptions of teaching. BMJ, 329(7469), 770–773. https://doi.org/10.1136/bmj.329.7469.770
— Examines how hierarchical teaching and public shaming shape the hidden curriculum of health professions education.
Murphy, R. J., Gray, S. A., Sterling, G., Reeves, K., & DuCette, J. (2009). A comparative study of professional student stress. Journal of Dental Education, 73(3), 328–337.
— Confirms that dental students experience higher stress and lower perceived control than medical and law students.
Polychronopoulou, A., & Divaris, K. (2009). Dental students’ perceived sources of stress: A multi-country study. Journal of Dental Education, 73(5), 631–639.
— International survey revealing consistently elevated stress levels among dental students compared to medical peers.
Sanders, A. E., & Lushington, K. (1999). Sources of stress for Australian dental students. Journal of Dental Education, 63(9), 688–697.
— Identifies workload intensity and simultaneous academic–clinical demands as leading stressors.
Scott, K. M., Caldwell, P. H. Y., Barnes, E. H., & Barrett, J. (2015). “Teaching by humiliation” and mistreatment of medical students in clinical rotations: A pilot study. Medical Journal of Australia, 203(4), 185.e1–185.e6. https://doi.org/10.5694/mja15.00189
— Provides empirical evidence that humiliation was normalized in clinical education and perpetuated by hierarchical culture.
Tedesco, L. A. (1986). A psychosocial perspective on the dental educational environment. Journal of Dental Education, 50(10), 601–605.
— Pioneering work linking the structure of dental education to psychological stress and student well-being.
Tisdelle, D. A., Hanley, R. E., & Davis, S. F. (1984). Stress management training for dental students. Journal of Dental Education, 48(4), 196–202.
— One of the first controlled studies evaluating stress-reduction interventions for dental students.
Wear, D., & Skillicorn, J. (2009). Hidden in plain sight: The formal, informal, and hidden curricula of a psychiatry clerkship. Academic Medicine, 84(4), 451–458. https://doi.org/10.1097/ACM.0b013e31819a82f7
— Explores how informal learning and shaming behaviors persist within modern medical and dental training.
Wigg, L., Li, W. W., Leow, T., et al. (2024). A systematic review and meta-analysis on teaching by humiliation (TBH). Medical Education Online. https://pubmed.ncbi.nlm.nih.gov/40144078/
— Comprehensive meta-analysis linking humiliation-based teaching with adverse psychological outcomes in medical education.
Confronting Mediocrity 