This study provides valuable insights into factors influencing dental students’ intentions to pursue oral and maxillofacial surgery residency in Israel. Our findings reveal a complex interplay of factors shaping students’ career intentions throughout dental education.

A key finding was the significant decline in OMFS specialization interest as students advance through their studies, from 54–58% in early years to 30.6% in the sixth year. For each additional year of study, the odds of interest in OMFS residency decreased by approximately 24%. This decline occurs predominantly after students enter clinical years, suggesting that factors within the clinical environment may contribute to this trend. This finding aligns with previous research noting similar declining interest patterns among advancing dental students [6, 22].

This decline could be attributed to exposure to various dental specialties, leading to diversification of career interests. While such diversification could contribute to a balanced distribution of specialists across dental fields [7], it raises questions about current OMFS education effectiveness in maintaining student interest. Additionally, perceived difficulty of OMFS residency or concerns about work-life balance may become more prominent as graduation approaches [8].

The observed decline in OMFS interest during clinical years can be explained through several interconnected mechanisms. Clinical exposure may create “reality shock” as students transition from idealized perceptions to direct observation of OMFS practice demands, including intensive training requirements, emergency responsibilities, and challenging work-life balance [8]. Simultaneously, exposure to multiple dental specialties during clinical rotations provides competing alternatives that may better align with students’ evolving preferences [7]. Poor mentorship quality due to overcrowded rotations may limit meaningful professional relationships that typically inspire specialty pursuit [11, 12], while direct surgical exposure may reveal skill gaps or comfort level mismatches that decrease students’ self-efficacy beliefs regarding their potential success in OMFS [23].

The cultural influence observed among Arab-Muslim students likely reflects complex socio-cultural factors including differential prestige attributions to surgical specialties, perceived opportunities to serve underserved community populations, and availability of culturally similar role models [11, 14]. These findings suggest that interventions should focus on early positive exposure with dedicated mentorship [12, 24], realistic job previews to reduce later disillusionment [25], and culturally sensitive career counseling that acknowledges diverse student backgrounds and motivations [14]. Understanding these theoretical mechanisms enables more targeted educational strategies to maintain student interest throughout dental training [5, 26].

Importantly, previous OMFS experience emerged as a significant positive predictor of interest in OMFS residency. Students with any type of OMFS experience were approximately 1.8 times more likely to express interest in OMFS residency, underscoring the importance of early exposure to OMFS practice. This finding aligns with research showing that direct experience with OMFS procedures positively impacts students’ interest [9, 27]. Such experiential learning demystifies complex surgical procedures [28], showcases OMFS impact on patients, and facilitates mentorship connections crucial for specialty selection [24].

A notable contrast exists between effects of personal OMFS experience and educational progression. While OMFS experience increases specialty interest, advancing through dental education decreases it. This contradiction may be explained by personal experiences showcasing real-world specialty impact, whereas educational exposure might emphasize theoretical challenges [8]. As students progress, exposure to various specialties may redirect interests [7], and awareness of residency demands may influence career decisions [24].

Our mediation analysis revealed that while year of study had a negative direct effect on residency intention, OMFS experience partially mediated this relationship. The positive indirect effect suggests students with OMFS experience maintain greater interest despite educational progression, highlighting potential for targeted interventions [5].

The influence of ethnic background on OMFS residency intention, with Arab-Muslim students showing higher odds of interest compared to Jewish students, suggests cultural or community factors play a role in specialty choice. This aligns with research on cultural influences in medical specialty choices [11, 14]. However, further investigation is needed to understand specific cultural dynamics in the Israeli context.

Notably, gender was not a significant predictor of OMFS residency intention, contrasting with studies finding gender differences in specialty choice [7, 11]. This could indicate progress toward gender equity in OMFS interest among Israeli dental students. However, equality in interest may not translate to equal field representation, as other factors influence career pursuit: work-life balance considerations [8], mentorship availability [11], institutional support [2], financial considerations [7], and cultural expectations [29].

These findings have important implications for dental education and OMFS recruitment. They highlight the need for early, sustained exposure to OMFS throughout dental education while improving OMFS education content and presentation [12]. Strategies could include guest lectures from OMFS practitioners, shadowing opportunities, and workshops emphasizing both technical skills and OMFS impact on patients. The positive association between previous OMFS experience and interest suggests providing more hands-on experiences could increase specialty interest [28].

Maintaining student interest throughout dental education requires collaborative efforts between dental schools, OMFS departments, and professional organizations. These stakeholders should implement mentorship programs, create research opportunities, and offer advanced electives in later years [24]. Regular exposure to OMFS cases throughout the curriculum could counteract the observed interest decline.

This study has several limitations. The cross sectional design cannot establish causal relationships. While we found consistent core OMFS exposure across cohorts despite COVID-19 affecting some students’ educational delivery, a cross sequential design would provide stronger evidence for OMFS interest trends. Additionally, the study’s focus on Israeli dental education may limit generalizability. Although our sample size was adequate, a larger sample across more institutions could strengthen the findings. A significant limitation of this study was the absence of direct inquiry into specific reasons underlying students’ interest or disinterest in OMFS specialization. While our survey effectively measured interest levels and identified associated factors, it did not capture the underlying motivations, concerns, or specific attributes that influence students’ career decisions. This limits our ability to develop targeted interventions and reduces the actionability of our recommendations. Future studies should incorporate qualitative components or structured questionnaires that specifically explore factors such as perceived work-life balance, financial considerations, training difficulty perceptions, mentorship quality, and specialty prestige factors.

Future research should prioritize mixed-methods approaches that combine quantitative trend analysis with qualitative exploration of decision-making factors. Specifically, studies should investigate the specific reasons behind declining OMFS interest during clinical years through structured interviews or focus groups. Research should also examine the relative importance of various factors (e.g., lifestyle considerations, financial prospects, training demands, and mentorship quality) in specialty selection decisions. Additionally, intervention studies testing the effectiveness of specific educational strategies—such as enhanced mentorship programs, realistic job previews, or modified rotation structures—could provide evidence-based approaches to maintaining student interest in OMFS throughout dental education.