Dental caries is a significant public health concern and one of the most prevalent chronic diseases globally. In Saudi Arabia, the incidence of dental caries is high in both pediatric and adult populations, with studies estimating a prevalence of approximately 80% (1). Despite this high prevalence, the utilization of dental services remains suboptimal owing to various barriers, including prolonged wait times, dental anxiety, a perceived lack of need for care, and the financial burden of treatment, among others (2). Addressing these challenges and promoting preventive dental care have become priorities in Saudi Arabia. This commitment is encapsulated in the National Transformation Program (NTP), which aligns with Vision 2030 to enhance the public healthcare sector and diversify the economy (3). The dentist-to-patient ratio and the number of trained dental professionals graduating in Saudi Arabia are gradually improving, reflecting a growing interest in postgraduate education among dental students (4, 5). Medical and dental institutions are adapting to evolving healthcare demands and patient expectations while accommodating the diverse backgrounds of students by incorporating innovative teaching methodologies (6). The Saudi Commission for Health Specialties (SCFHS) is actively monitoring these developments and has accredited up to 21 master’s degree programs in the field of dentistry (7).

The Saudi Board in Restorative Dentistry (SBRD), now referred to as the Saudi Specialty Certificate in Restorative Dentistry [SSC-(Resto)], represents a favored pathway for many dental graduates, boasting the highest enrollment of dentistry residents as of 2023 (6). The program has integrated the CanMEDS 2015 framework to define core competencies for residents, with the objective of enhancing patient care (6, 8). The SBRD program encompasses a rigorous 3-year curriculum combining didactic instruction and clinical training, aiming to elevate dental standards in Saudi Arabia by equipping dentistry residents with the necessary skills to excel as restorative dentists. The program comprises 2 distinct phases: supervised junior residency and independent senior residency (9).

The oversight of the residency program in Saudi Arabia is administered through multiple levels of authority, with program directors (PDs) playing a pivotal role in the selection of candidates (10). The evaluation process allocates 55% of the total score to the Saudi Licensing Examination (SDLE) and 30% to the grade point average (GPA). The remaining 15% is distributed across various domains, including research, service/electives, interviews, and letters of recommendation (11). However, the specific importance assigned to these domains and the precise inquiries prioritized by PDs who are in the process of selecting candidates remain ambiguous. Gaining insight into these priorities is crucial for prospective candidates aiming to target key areas that may enhance their prospects of acceptance (12).

Previous investigations in Saudi Arabia on this topic have focused on the medical sector, exploring the views of PDs in specialties such as plastic surgery, pediatrics, orthopedics, and urology (10–13). While research has been conducted in some dental specialties, such as orthodontics and periodontics, these studies have primarily been descriptive and often lack comparative analyses (14, 15). Furthermore, they have tended to focus on a limited range of factors related to program selection, such as geographical region and professional experience (15). Given the significant variation in requirements and expectations across specialty program selection processes, the growing popularity of the SBRD program, and the lack of prior studies on this topic, this study aims to fill that gap by examining PDs’ perspectives on the residency candidate selection process for the SBRD program. It also aimed to compare these views based on the PD’s sex, current position, years of experience, across hospital settings, and geographic locations within the Kingdom of Saudi Arabia. This study offers a comprehensive analysis across these key PD characteristics, filling a critical gap and enhancing understanding of candidate selection in SBRD programs.

This study was conducted to evaluate the perspectives of PDs on candidate selection for an SBRD program. To our knowledge, this is the first study in KSA to focus on restorative PDs. Previous research has primarily focused on periodontic and orthodontic PDs in dentistry, as well as on PDs in other medical programs. The findings of this study revealed that interviews were the most favored domain among the PDs, followed by services and electives. Specifically, individual queries revealed higher preferences for candidates’ performance and reputation during electives, having worked as service residents, and being well dressed during interviews. Conversely, factors such as pursuing electives abroad, the number and mode of recommendation letters, and being on the dean’s honorary list did not positively influence the perceptions of the PDs. These trends remained consistent across the various PD-related factors examined in this study, except in the interview domain, where responses varied according to PD experience level.

The lower average values of the GPA and examinations domains compared with other domains in this study may have resulted from the fact that the GPA and SDLE had predefined weights. The selection process for the SCFHS Board programs assigns 55% importance to the SDLE examinations, 30% to the GPA, and the remaining 15% to other factors (12). Assuming all candidates reached the next stage with good GPA and SDLE scores, the PDs likely concentrated on other aspects of the selection process. A similar finding was reported for plastic surgery PDs in Saudi Arabia (10). However, specific elements within these domains, such as the significance of the graduating school, being on the dean’s honorary list, awards earned during dental school, and the influence of passing international examinations, required further exploration and were therefore included in the survey. GPA provides an overall assessment of graduate academic performance; however, some studies have focused specifically on clinical grades during dental school (17). The SBRD emphasizes clinical competencies; therefore, it is plausible that greater weight is placed on clinical performance than overall GPA. The lower average scores in these domains may also be due to lower scores on individual questions, such as being on the dean’s honorary list and passing international examinations, which affected the domains’ total scores despite the high importance placed on the SDLE examinations. A previous study on PDs for the Saudi Board Pediatric program ranked the Saudi Medical Licensing Exam (SMLE) as the highest priority (11). The SDLE and its counterpart, the SMLE, serve as licensing examinations for practicing dentistry and medicine in Saudi Arabia, underscoring the significance that PDs attach to these assessments. A reasonable explanation for this strong appeal is that licensing is essential for clinical work throughout the programs, and those who achieve strong scores demonstrate a sufficient level of knowledge and ability to excel in competitive examinations.

Research experience is vital for strengthening a candidate’s application to dental residency programs (18). A solid understanding of oral biology relies on foundational knowledge, research skills, and appreciation for research, which often play a key role in postgraduate admissions (19, 20). Despite growing interest in research-based postgraduate education, programs with a dedicated research unit tend to emphasize research more than those with a primary clinical focus (21). In this study, consistent with findings from various dental programs, the aggregate score for the research domain was lower than that for other domains (14, 17). Nevertheless, individual factors, such as the significance of basic research knowledge, were prioritized. Furthermore, PDs placed emphasis on the quality of candidates’ research and the prestige of journals over mere publication output, as reflected in their responses. A possible reason could be their understanding that publishing in esteemed journals demands high-quality research and considerable investment in time and effort (22).

In this study, the interview domain emerged as the most popular choice for restorative PDs, followed by services and electives. Interviews remain an integral part of the selection process; however, the academic results may not necessarily match the interview ratings (23). The candidate’s choice of professional attire during the interview was among the most significant factors influencing PDs in the present study. This finding is consistent with results from a study of Saudi pediatric PDs, in which the most important element of interviews was the ability of the candidates to present themselves well through appropriate dress (11). Conversely, Saudi urology PDs placed less emphasis on this aspect (13). The impact of being well dressed is twofold: it enhances self-confidence and creates a positive impression on the interviewer. Conversely, those dressed unprofessionally are often perceived negatively, particularly within a noble profession such as dentistry (24). In studies focusing on periodontic and orthodontic PDs in the United States, the interview process had consistently emerged as a pivotal criterion for candidate selection (17, 25). Interviews provide a valuable opportunity to assess students’ knowledge and expertise in restorative dentistry, as evidenced by the higher means observed in this study. In plastic surgery, orthopedics, and urology programs in Saudi Arabia, PDs placed significant emphasis on their personal interactions with candidates during the interview process (10, 12, 13). These interactions helped deepen their understanding of the candidates’ knowledge and capabilities.

The importance placed on candidates who completed electives abroad was minimal in this study, which aligns with previous research (13, 14). This may be attributed to a lack of understanding of and connection with the international centers where these electives have occurred, which subsequently constrained the ability to obtain valuable feedback on the candidates’ performances. Conversely, candidates who worked as service residents in the restorative field and demonstrated strong clinical skills and positive rapport with staff were the most appealing to PDs among the other domains. This preference likely indicates a demonstrated commitment, signifying a clear dedication to pursuing a postgraduate degree in restorative dentistry (11, 13, 14). Given the significance of this result, it should remain the primary focus of aspiring candidates.

Contrary to previous studies that underscored the importance of recommendation letters in the evaluation process, we identified the domain of recommendations as the least prioritized by the restorative PDs. In a study of oral surgery PDs in the United States, Laskin et al. found that 90% of the respondents agreed on the importance of recommendation letters in candidate selection, particularly those received from university faculty (26). Notably, in our study, the mode of recommendations and the requirement for multiple letters received the lowest ratings, adversely affecting the overall average for this domain. The oral surgery PDs in the United States study preferred letters over recommendation forms, reporting that letters would provide more information, suggesting a possible review of the content and language of the letter (26). A study of pediatric PDs in Saudi Arabia reported similar findings to ours, indicating minimal emphasis on recommendation letters in their assessment criteria (11). However, recommendations hold particular weight when sourced from reputable individuals within the same profession. Other significant factors, although often considered supplementary, are candidates’ English language proficiency and, to a lesser degree, their involvement in community services. Previous research has also highlighted the importance of English language skills in candidate evaluation (14).

New PDs with < 1 year of experience tended to rely more on recommendation letters and less on interviews than their more experienced counterparts, resulting in a statistically significant difference. Notably, the difference in means was particularly pronounced in the responses concerning the value of the interview along with the GPA, where less experienced PDs tended to respond negatively. This may be attributed to their reliance on external recommendations rather than independent evaluations of candidates during the interview process. A previous study on Saudi urology PDs identified significant differences in experience levels regarding queries about recommendation letters from non-urologists (13). Although differences were noted in other queries involving PD variables in the study, they were not statistically significant.

Our study had several limitations that should be considered when interpreting the results. First, the small sample size and the use of convenience sampling may introduce selection bias, which could limit the generalizability of our findings. Second, variations in responses across different variables within each domain may have influenced the results. Despite these limitations, we believe that the findings of this study hold significant value. Furthermore, this is the first study to examine PDs’ perspectives on candidates for restorative dentistry programs. Our findings could be especially useful for prospective candidates, given the strong demand for restorative dental courses in Saudi Arabia. The outcomes of the study should be regarded as specific to the SBRD. Nevertheless, these selection dynamics may be relevant to other board programs in dentistry and medicine in Saudi Arabia that operate under comparable frameworks established by SCFHS. However, they may not generalize fully to other or international training systems, as evaluation criteria can vary. To distinguish among candidates, programs should adopt standardized, competency-based interview frameworks that include structured scoring rubrics to reduce the inherent subjectivity in these assessments. Additionally, formalizing assessment criteria for service residency and elective performance, such as standardized evaluation forms or minimum competency checklists, may also help reduce variability among programs. Ultimately, such results would assist programs in refining their selection processes to better identify and attract the most suitable candidates.

In conclusion, while all components of the evaluation process carried varying degrees of significance, PDs placed particular emphasis on candidates’ skills and performance during electives and on those who worked as service residents. Furthermore, the professional appearance of the candidates during the interview positively influenced the perceptions of the PDs. Given the minimal variability observed among the PD-related variables examined in this study, we can infer a consistent selection pattern across the SBRD program.