Social, Academic, and Family Factors Associated With Academic Repetition in Dental Students*

Background: Student repetition is a multifactorial phenomenon, of a socio-educational type, associated with different characteristics (sociodemographic, academic, family) in students of institutions, being a recurring manifestation in university institutions, which makes evident the need to identify the factors that intervene in the process, which would help to avoid or reduce dropout. Purpose: to determine the academic, social and family factors associated with student repetition in dental students from a university institution on the Colombian Caribbean coast. Methods: descriptive, cross-sectional study, in a representative sample of dental students in a repetition and non-repetition condition, who voluntarily answered a validated instrument to measure, in addition to sociodemographic characteristics, the associated factors that may influence student repetition and familiar functionality. Results: of 244 participants with a predominance of the female gender, 40,2 % repeating. they never received vocational guidance (19,4 %), in general they reported good family functionality (91 %). The factors associated with student repetition were: socioeconomic status, academic levels and income of the parents, Saber11 test results and the number of times they have repeated a semester and / or a subject. Conclusion: The identification of these factors allows the design of strategies that encompass the impact of this condition so that higher education institutions can act in a timely manner to reduce these rates.


INTRODUCTION
At present, with the advent of globalization, the concept of university has been transformed until it is understood as a space in which the development of competencies (logical, interpretive, argumentative, propositional) for the adoption of roles and reflective, critical and creative attitudes that allow the resolution of problems in the social context (1,2). Within this, it is important to highlight that education at the undergraduate level demands a greater demand from students to fulfill their professional training (3). However, on multiple occasions these demands are hampered by the low performance of the student, due to various factors that may be of sociodemographic, economic and / or related to the academic dimension, study plans and educational resources, which directly affect the repetition of the student and as a consequence of this in the student dropout (4).
For this reason, student repetition is one of the concerns shared by all educational systems in Colombia and in the world since it is the first step in the final process of university dropout. Therefore, it is considered a standard indicator below the school criteria issued by any institution, related to the minimum domain that the student must have to comply with the competencies of a subject (5,6).
In the Latin American context, the situation of university education is not alien to or different from the great situation of global concern, in terms of low academic performance, university repetition and therefore student dropout (7). In the World Bank report (2017) it is estimated that countries such as Nicaragua, Panama, Bolivia, Ecuador and, unfortunately, Colombia, presented high rates of university dropouts, which suggests restructuring their educational systems in order to thus reduce rates. dropout rates and increase the quality of their educational systems (8).
For its part, in Colombia, the System for the Prevention of Drop-Out in Higher Education (SPADIES) has made progress in the centralization of information, through the development of public policies in favor of mitigating this situation, starting from the decrease in the rates of university repetition, in order to combat the high dropout rates and its negative impact on political, economic, social and cultural processes (9). Likewise, according to the Ministry of National Education (MEN), it states that the highest dropouts are found in technical and technological programs, and for professional programs it is 44.93%. For its part, for the department of Bolívar in 2015, the dropout rate was 44.8% (10).
Regarding the area of health sciences and specifically in the dentistry program, it has been evidenced that students refer as the main cause of repetition the short time to study, the method used by the teacher and difficulty in economic resources, which affects the quality of education due to several factors in which they can be mentioned, extra-age, that is, the gap between school age and chronological age, dropout and repetition, the latter being the highest Interest due to the fact that financial resources must be invested in students who have repeated the same subject or semester 2 or more times and therefore have not been able to be promoted, which leads to student academic failure (11,12).
Other researchers such as Pérez et al, report that the causes of school dropout and repetition were absences from classes, teachers who were not very explicit in their classes, little help provided by the teacher in tutoring students, exam questions were sometimes not fit the content taught, the excessive amount of self-employment, among others (13). Also, the difficulty in financial resources by the students turns out to be the greatest inconvenience for their academic performance, followed by the absence of patients from their clinics and the lack of theoretical knowledge (14).
Based on this situation, it is necessary to make a particular identification in higher education institutions to identify the factors associated with the repetition of dental students, so that specific interventions can be carried out to reduce university dropout rates. In addition, it is essential to take into account that repetition generates economic effects that lead to additional costs for the family and the student, conditioning the prolongation of the professional cycle that affects the expectations of family well-being and generates possible feelings of failure, demotivation and low income. self-esteem. The need arises to determine the social, academic and family factors associated with student repetition in a dentistry program in the city of Cartagena, Colombia. For which the following research question is formulated: What are the social, academic and family factors associated with student repetition in a dentistry program in Cartagena de Indias?

Type of study
Descriptive cross-sectional study. The population consisted of 244 students from a dental program enrolled in the first period of 2019. The following inclusion criteria were used: students over 18 years of age, in a state of repetition and non-repetition, academically active within the dentistry program and excluded students who did not accept their participation in the study through informed consent.

Assessment of factors associated with repetition
Prior to the process of carrying out the study, the students in a state of repetition and non-repetition of the dentistry program were informed of the objective and benefits of the study, based on a dialogue with the groups of students involved in order to obtain their participation. voluntarily. To A questionnaire divided into two parts was used: the first comprises an instrument validated by Muñoz and Olivera (2015) (16) which presents a Cronbach alpha of 0.709, which uses a Likerttype scale that allows measuring sociodemographic characteristics and associated factors that possibly influence the repetition process of the students, in addition the results of the ICFES Saber 11 were taken into account, in scores of 1-500 in which they were categorized into three levels: high (333-500), medium (167-332) and low . In addition, the family APGAR was applied; Suárez and Alcalá (2014) (17), a validated questionnaire for the assessment of family functionality, which presents a Cronbach alpha of 0.793 and consists of 5 questions, where each question can take a value of 0 and 4 points, which that when totaling the maximum value that can be obtained is 20 points and they were categorized into mild dysfunction, moderate dysfunction, severe diffusion and good functionality, considering that an individual has good family functionality when the score obtained is in a range of 17 to 20 points , mild dysfunction from 16 to 13 points, moderate from 12 to 9 points and severe those values less than 9 points.

Statistical analysis
For the tabulation and compilation of the information, a database was designed in the Microsoft Excel v2016 program. The information analysis was carried out using the SPSS V22 software in Spanish, using descriptive statistics by means of a univariate analysis by using the frequency and percentage measure for the qualitative variables, and measures of central tendency accompanied by dispersion measures. for continuous variables of a quantitative nature. To analyze the tendency to the statistical association between the study variables: sociodemographic and academic with the state of repetition of the population under study, a bivariate analysis was performed using Chisquare and the value of its probability was accepted as a significant statistical a value of p <0.05.

Ethical considerations
The present study had the authorization and ethical endorsement before the ethics committee of the sponsoring institutions. Likewise, it takes into consideration regulations such as the

Declaration of Helsinki and resolution 008430 of 1993 of the Ministry of Health and Social
Protection of the Republic of Colombia. Informed consent was requested from the student to participate in the study, guaranteeing confidentiality and respect for dignity.

Sociodemographic characteristics
Of the 244 participants, 64.3% are female. Most of the participants were in an age range between 23 to 26 years, 86% of the participants were single, with a predominant socioeconomic stratum of stratum 2 in 39.3% and they came from the department of Bolívar and they resided in the city of Cartagena. Regarding the family environment, it was observed that 86% do not have children, 77% live with their parents and 93% do not work. The educational level of the parents is professional (32.4%), while that of the mothers is secondary (30.7%), apart from 50.8% of the parents have an economic income between 5 to 6 SMLV (Table 1).  Regarding the factors associated with repetition, the participants answered never having received vocational guidance or having decreased their academic performance and stopped showing up due to problems related to their health or having difficulty adapting to the university environment or having family and emotional conflicts. However, between 13% to 16% rarely said they were afraid of being wrong when participating in the classroom or having a fixed schedule dedicated to their academic activities or having feelings of guilt or reviewing the topic before being seen (table 3).
Likewise, they affirm that they have sometimes attended classes, but are tired or go to support activities at the university. Likewise, they reaffirm systematically studying the contents of the study plan, dedicating proportional time to each subject. However, between 17% to 22% of the participants commented on some occasions, feeling lack of motivation towards their career, dedicating the necessary time to their studies, presenting problems communicating, possessing previous knowledge and having difficulty memorizing the thematic contents (table 3).

DISCUSSION
The present study allowed the sociodemographic characterization of the study subjects and their relationship with repetition in dental students of a particular program, however, despite the fact that these results cannot be generalized to all dental schools, if they agree to identify Factors that may be common to all dentistry programs, which would allow the design of improvement actions in favor of quality indicators and the reduction of desertion in university students in Health Sciences Programs. In the present work, repetition was evaluated, as it was understood as the action of repeatedly pursuing an academic activity, either due to poor student performance or due to causes beyond the academic field during a period (year, semester or quarter (18,19). It is necessary to identify the academic, social and family factors associated with student repetition in a dental socioeconomic stratum (stratum 1 and 2), in relation to family functionality it was found that 91% of students have good family functionality, not However, 14.3% of the participants in the present study stated that they intended to withdraw from the university.
Finally, Díaz S, et al associated academic stress and family functionality in dental students, reporting that among the situations that generate stress are teacher evaluations, restlessness, despair, drowsiness and lack of organization of academic activities. Regarding family functionality, the APGAR reported good family functionality in 38.25%, followed by mild dysfunction in 31.8% (26). When relating these findings to the present study, a relationship was found because 13.3% attend classes, but are tired and fatigued about its development and 18.4% only sometimes dedicate the necessary time to their studies or academic activities. On the contrary, this study reported that the participants have good family functionality, which is considered an important factor on school repetition due to aspects such as type of family, educational level, economic income and the support of the family towards their children. / as can affect the academic condition of students.
However, an important limitation corresponds to the design of the cross-sectional study, for future investigations the implementation of longitudinal studies is suggested, which allows obtaining complementary information and thus carrying out the necessary interventions since student repetition is linked to emotional factors , which are fluctuating and changing over time.
The results obtained in this research were presented to the academic authorities of the Program for their evaluation and the taking of improvement actions.

CONCLUSION
The identification of factors associated with repetition in students will allow establishing new teaching and learning methodologies to increase effectiveness and motivation during their academic training, as well as higher education institutions so that they can act in a timely manner in the reduction of these indices. Therefore, it is necessary to follow up students who drop out or show recurrent repetition during the training of the degree.