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Learn more: PMC Disclaimer | PMC Copyright Notice Ethiop J Health Sci . 2025 Jul;35(4):282–293. doi: 10.4314/ejhs.v35i4.8 Search in PMC Search in PubMed View in NLM Catalog Add to search Education Cost of Dental Students Using the Activity-Based Costing Method at Iran University of Medical Sciences Mahmoud Zamandi Mahmoud Zamandi 1 Iran University of Medical Sciences, Tehran, Iran Vice President of International Affairs Find articles by Mahmoud Zamandi 1 , Behzad Raei Behzad Raei 2 Department of Health, Safety, and Environment Management, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran Find articles by Behzad Raei 2, ✉ Author information Article notes Copyright and License information 1 Iran University of Medical Sciences, Tehran, Iran 2 Department of Health, Safety, and Environment Management, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran Funding : This research was financially supported by the Vice President for International Affairs at Iran University of Medical Sciences. The funding body had no role in the design of the study, data collection, analysis, interpretation, writing of the report, or the decision to submit the report for publication. Competing Interests : The authors declare that this manuscript was approved by all authors in its form and that no competing interest exists. ✉ Email: [email protected] ✉ Corresponding author. Roles Mahmoud Zamandi : Vice President of International Affairs Received 2024 May 19; Accepted 2025 Apr 28. © 2025 Mahmoud Z., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMC Copyright notice PMCID: PMC13077173 PMID: 41987862 Abstract Background Accurate cost and pricing information is essential for optimal budget allocation and sound strategic decision-making. Establishing an appropriate costing system is critical for understanding educational expenses, improving services, and managing budgets more efficiently. This study aimed to estimate the cost of educating students at the dental school during the 2022-23 academic year. Methods This cross-sectional study estimated the cost of educating dental students at Iran University of Medical Sciences in 2023 using the Activity-Based Costing (ABC) method. Data were collected through interviews with financial and administrative officials, as well as relevant units such as accounting and administration, utilizing a structured checklist. After estimating the costs of activity centers, overhead and intermediate center expenses were allocated to final activity centers based on suitable allocation bases. Ultimately, the costs associated with the final activity centers which is, the educational departments, were determined, and the total cost per student was calculated. Results The average cost of educating a general dentistry student in the 2022-23 academic year was approximately 132,438 Purchasing Power Parity (PPP) adjusted US Dollars. In the dental school, total overhead costs amounted to 802,953, while total direct costs were 1,133,853 in PPP-adjusted dollars. The largest portion of total costs (61%) was attributed to human resources, followed by consumables (20%) and equipment depreciation (14%). Conclusion The majority of costs are allocated to human resources, indicating the need to enhance productivity. Reducing consumable costs and equipment depreciation could further improve financial efficiency. It is recommended that managers and policymakers implement strategies to optimize resources and enhance educational quality. Keywords: Dental Education, Costing, ABC, Education Economics Introduction The increase in the minimum wage and the rise in per capita Gross Domestic Product (GDP) have led to higher tuition and educational costs in dentistry, to the extent that these increases could eventually be passed on to patients, thereby limiting access to dental services for low-income households. In response, governments have decided to provide universities with subsidies to help manage tuition fees ( 1 ). In addition to tuition, living expenses and the loss of income during a four- to five-year academic period impose a significant financial burden on students. These costs create a barrier, particularly for low-income groups who are more reliant on loans to continue their education. Overall, costs are a key factor in valuation, and the payment of expenses is a major issue involving all stakeholders, including the university, government, students, professors, staff, patients, and alumni ( 2 ). Dental courses are typically among the most expensive educational programs, as they require the provision of specific clinical experiences for students ( 3 ). This study explores the rising costs of dental education and their impact on students, particularly at Iran University of Medical Sciences. The central issue addressed is how escalating tuition, living expenses, and the loss of income during study affect students' financial stability and their ability to enter the dental profession. More specifically, the study aims to estimate the cost of dental education using the Activity-Based Costing (ABC) method, which provides a more accurate measure by identifying various activities involved and assigning associated costs. Students living in rented accommodations face significantly higher annual living expenses compared to those residing in their family homes. Many students do not have an additional source of income and rely on financial support from their families, indicating a lack of economic and social diversity. Consequently, the high cost of education and associated living expenses can prevent many talented students from low-income families from pursuing further education in the dental field ( 4 ). In the United States, tuition fees for dental schools vary considerably, from approximately $20,000 per year at public universities to as much as $90,000 per year at private institutions. The average annual tuition is generally around $50,000, which typically covers only the cost of education, excluding other expenses such as miscellaneous fees, dental equipment, housing, and food, which can total up to $200,000 per year. It was previously believed that the increase in the number of dental graduates and dentists would lead to competition among them, thus driving down the cost of dental services ( 5 ). In the United States, rising educational costs have led to a significant increase in student loan debt, which reached $1.2 trillion by May 2013, making it the second-largest category of consumer debt after mortgages. This escalation in costs and student loan debt remains a major concern for students and their families ( 6 ). The costs of dental education are a significant issue for students, families, universities, and the broader healthcare system. Understanding these costs and their impact on access to dental services is essential for informing policy decisions. As tuition rates and living expenses continue to rise, the importance of this study grows, especially in low-resource settings where these costs may prevent talented students from entering the dental profession. The ABC method provides a detailed and more precise way of understanding educational costs, helping institutions better manage resources. The link between investing in education and the development of human capital, which drives economic growth, rests on the notion that such investments may not yield immediate returns but will result in both financial and non-financial benefits in the future ( 7 ). A cost-benefit analysis study found that the average rate of return on investment in dental education was 29.4%, exceeding the stock market's return rate of 14.35%. The study also revealed that over a 12-year period, the costs of obtaining a dental degree increased at an annual rate of 4.45%, while the average annual income of dentists grew by 3.8% ( 8 ). In countries with limited resources and inadequate infrastructure, continuous evaluation of the educational environment's impact on dental education is even more critical. In such contexts, dental educators must adopt student-centered teaching approaches to achieve the best outcomes ( 9 ). Given the increasing costs of dental education and their burden on students, this study is necessary to assess the financial strain placed on students, particularly those from low-income backgrounds. Additionally, in countries with limited educational resources, understanding the impact of educational costs becomes even more urgent. By using the ABC method, this study provides clearer insights into the cost structure of dental education, offering valuable data for policymakers to make informed decisions on subsidies and resource allocation. Training an optimal number of dentists at a reasonable cost for both students and institutions requires fundamental changes to educational programs. These changes include redesigning the educational process, adjusting the duration of study, and developing curricula tailored to different regions. Without adopting more effective teaching methods, the future of the dental profession may face undesirable outcomes ( 10 ). Therefore, those considering dentistry as a career need more comprehensive information, including direct educational costs (e.g., tuition, books, stationery, and dental instruments) and indirect costs (e.g., lost income during the study period). Cost analysis, as an economic tool in decision-making, can assist managers in improving program effectiveness. By attributing direct and indirect costs, costing helps managers and policymakers determine whether costs exceed total revenues and available subsidies ( 11 ). Moreover, unit cost analysis plays a crucial role in planning, budgeting, control, and organizational assessment. By evaluating the performance of cost centers and comparing it with budgeted outcomes, managers can identify areas that need attention and take corrective action ( 12 , 13 ). This study's objective was to estimate the cost of educating dental students at Iran University of Medical Sciences for the 2022-23 academic year using the Activity-Based Costing (ABC) method. Methods This applied study estimates the total cost of educating a dental student at Iran University of Medical Sciences (IUMS) during the 2022-23 academic year using the ABC method. Data were gathered through interviews with the financial and administrative officials of the faculty, as well as an analysis of documents from the accounting and administrative departments. Data were collected using a researcher-developed checklist and analyzed with Microsoft Excel 2013 software. In the ABC system, costs are assigned to activities based on the resources they consume in delivering services. The core principle is that services use activities, which in turn consume resources. Therefore, costs are first allocated to activities, and these activity-related costs are subsequently assigned to cost objectives using appropriate allocation bases. Costing is the process of determining the total cost of activities necessary for providing services or products. In this study, after defining activity centers and conducting costing, the process of allocating costs from overhead activity centers to final activity centers (educational groups) was carried out. Suitable bases for distributing the costs of overhead and intermediate centers were established ( Table 1 ). These bases facilitated the assignment of costs from each activity center to the final activity center. The specific costs for the educational groups were then estimated and added to the allocated costs. The portion of these combined costs attributed to each student within the educational group was calculated, and finally, the overall cost of educating each student was determined ( 14 - 16 ). Table 1. Cost centers and apportionment base Type of cost center Activity centers Apportionment base Overhead Head office Employees + Students facilities and technical office Area network room Employees + Students warehouse and boiler room Employees + Students water station Employees + Students lobby and public space Employees + Students prayer room Employees + Students administrative affairs Employees + Students electrical room Area Guard unit Employees + Students Accounting Employees Supply Unit Employees Security Employees + Students information technology Employees + Students Intermediate educational department Students medical equipment Students Admission Employees + Students changing room and dining area Employees + Students occupational health Students library and study hall Students suction room Students compressor room Students general practitioner Students Final Radiology Students Classes Students CSR Students plaster room Students unit hall Students Pathology Students Diagnostics Students restorative phantom Students Darkroom Students educational groups Students Open in a new tab To calculate the full cost of training dental students at IUMS using the ABC system, the study followed six steps: Step One: Analyzing the Faculty's Activity Processes and Communication In the first phase of the study, the operational processes of educational groups and their interactions with supporting activity centers—including both overhead and intermediate centers—were analyzed. It also examined the faculty's financial, accounting, and administrative systems to ensure the feasibility of subsequent steps. The cost structure in the education sector differs significantly from that in the production and service sectors. In production, a substantial portion of costs is attributed to consumables, equipment, and capital goods, with labor costs often being minimal. In contrast, the education sector is heavily reliant on human resources, with a significant share of costs attributed to faculty members and staff ( 15 , 16 ). Step Two: Identifying Activity Centers A critical component of the ABC system is the accurate identification and definition of activity centers. To achieve this, the study first analyzed the various activities and referred to the organizational chart to identify all relevant activity centers, ranging from leadership to educational groups within the faculty. These centers are responsible for generating direct costs internally and for incurring indirect costs through interactions with other centers. Step Three: Classifying Activity Centers by Their Services and Outputs Following the identification of activity centers, the study defined the services and outputs of each center, as well as the sequence of activities involved in delivering those services. The activity centers were classified into three primary groups based on their functions: Overhead Activity Centers : These centers provide general and support services to operational (final) and intermediate activity centers. They are not directly involved in delivering services to students or employees. Their costs are considered overhead for other units. Intermediate Activity Centers : These centers provide services to operational departments, students, and staff. They can be considered independent cost units. Centers that offer services to both intermediate and final activity centers, including educational groups, are classified as intermediate activity centers. Operational and Final Activity Centers : These centers are directly involved in service delivery. In this study, the educational groups that provide teaching services to students are recognized as the operational and final activity centers. These centers receive support from both overhead and intermediate centers. Step Four: Identifying Resources and Performing Costing for Activity Centers In this stage, after identifying and classifying the activity centers, data on resources and equipment related to each activity center were collected and assessed. This included information on building area, properties and equipment, human resources, consumables, and municipal services. Costing for each activity center was carried out based on the activity driver. The costs identified from the resources were as follows: Building depreciation costs : To calculate the depreciation costs of the building for each activity center, the construction cost per square meter in Tehran was first estimated. Using this information, the total construction cost was calculated with the data presented in Table 2 ( 13 , 15 ), applying the following formula: Table 2. Asset lifespan Fixed Asset Minimum lifespan (Year) Maximum lifespan (Year) High-quality building 50 100 Dilapidated and unstable building 15 50 Central facilities for steam and hot water generation 30 40 Elevators 20 30 Office furniture and equipment 10 20 Transportation vehicles and machinery 5 10 Medical electrical and mechanical equipment 10 20 Medical equipment for laboratory and surgical use 5 10 Non-electrical medical metal furniture 10 20 Stainless steel container 15 20 Laundry equipment 5 15 Workshop and firefighting equipment 10 15 Gardening tools 5 10 Open in a new tab Building Depreciation Cost = Building area × Cost per square meter of construction Useful life of the building The depreciation cost for each unit was then estimated based on its proportionate share of the building. Depreciation costs for each unit : The depreciation cost for each unit was estimated based on its proportionate share of the building. Equipment Depreciation Costs : To calculate the total cost, annual depreciation for equipment and capital goods, such as desks, chairs, and computers, was determined using the straight-line accounting method. The annual depreciation cost is calculated as follows: Annual Depreciation = Total current value − Salvage value Useful life of capital goods Human resource costs : Personnel costs for all activity centers, including salaries, benefits, insurance, taxes, deductions, etc., were collected and analyzed. Consumables and supplies costs : These costs included expenses for printing, purchasing publications, ceremonial costs, postal charges, consumables for facilities and computer units, research expenses, and administrative office and kitchen supplies. Utility costs : Utility expenses for water, electricity, gas, and telephone were collected from the accounting department and allocated to the units based on appropriate cost allocation bases. By summing the costs of building depreciation, equipment, human resources, consumables, and utilities, the total internal costs for each activity center were calculated. Step Five: Allocating the Costs of Overhead and Intermediate Activity Centers to the Final Centers In this study, the costs of each center were categorized into two groups: 1) specific costs within each activity center, and 2) costs allocated from other activity centers according to the allocation bases. The total cost of each activity center (TCi) includes both specific and overhead costs, calculated as follows: T C i = B i P B + ∑ n j = E i j P E i j + ∑ n j = L i j W i j + ∑ n j = C i j P C i j + U i P U + O C i Where: TCi = Total cost of activity center i Bi = Space occupied by center iii PB = Depreciation cost per square meter of the building Eij = Number of equipment units in group j in activity center i PEij = Depreciation cost of equipment j in activity center i Lij = Number of personnel in group j in activity center i Wij = Wages and benefits of personnel in group j in activity center i Cij = Number of consumable units in group j in activity center i PCij = Price per unit of consumable j Ui = Units of utilities (e.g., water, electricity, gas, telephone) consumed by activity center iii PU = Price of utilities OCi = Other costs associated with activity center i In the cost allocation process, overhead activity centers serve as the starting point for costing and cost allocation operations. The costs from both overhead and intermediate activity centers were assigned to the final activity centers using appropriate allocation bases. After calculating the total costs for each center, the overhead cost share from other centers was estimated by dividing the respective costs by their allocation base values. This process was repeated for each of the overhead and intermediate centers individually. The share of overhead costs assigned to the educational groups (final activity centers) represents the cumulative cost shares from all overhead and intermediate centers. Step Six: Calculating the Full Cost of Training a Student Once the total overhead and specific costs for the final activity center were calculated, the number of students was determined. The share of each student in the overhead and specific costs was calculated, which was then multiplied by the number of years required for study. This approach allowed for the determination of the full cost of educating each student throughout the entire course of study in dentistry. Ethical considerations : This study is derived from the research project with the Code of Ethics IR.IUMS.REC. 1402.774, conducted at the Vice President of International Affairs, Iran University of Medical Sciences, Tehran, Iran. Results The estimated average total cost of training a general dentistry doctoral student in the 2022-23 academic year at Iran University of Medical Sciences was approximately $132,438 (PPP), with an annual cost of $33,038 (PPP) during the educational phase and $16,591 (PPP) during the clinical phase. The analysis, which was based on activity identification and organizational charts from the dental school, identified a total of 33 activity centers, including 14 overhead activity centers, 9 intermediate activity centers, and 10 final activity centers. Overhead activity centers : These centers provide services to all other activity centers. Intermediate activity centers : These centers provide services to both intermediate and final activity centers, including educational groups. Final (operational) activity centers : These are the centers directly engaged in delivering services and training students. The educational groups, which provide teaching services to students, were recognized as the final activity centers, supported by overhead and intermediate centers. The results of this analysis are presented in a table, where all costs are adjusted based on the World Bank's purchasing power parity (PPP) conversion factors for 2022 in current international dollars. As illustrated in Figure 1 , personnel costs represent the largest share of total costs, accounting for 61%, while utility costs constitute just 1%, the smallest share. Figure 1. Open in a new tab Cost-share of direct cost components Direct (specific) costs: The direct (specific) costs associated with each activity center include depreciation of buildings and equipment, salaries and benefits of human resources, consumables, and utilities. The total direct costs for the final activity centers amounted to $1,133,853 (PPP), with theoretical courses accounting for $756,421 and practical courses for $377,432. Additionally, the total cost of the overhead activity centers was $802,953 (PPP). When combined, the total direct and overhead costs for the final activity centers reached $1,936,805 (PPP). Table 4 presents the breakdown of direct (specific) and overhead costs for both practical and theoretical courses. Table 4. Overhead and Direct (Specific) Costs by Academic Course ($PPP) Type of costs Academic course Theoretical Practical Overhead 234,721 568,231 Direct (specific) 756,421 377,432 Sum 991,143 945,663 Open in a new tab Table 5 presents the average annual cost and the overall cost of educating a student in each academic phase, ultimately leading to the calculation of the total cost of training a general dentistry student. Table 5. Cost of training a dentistry student ($PPP) Dentistry discipline Education level Number of students Average annual cost Number of schooling years Total cost of training Average cost of training a student Basic medical science course Doctorate 30 33,038 2 66,076 132,438 Clinical course Doctorate 57 16,591 4 66,362 Open in a new tab Discussion Dental education, traditionally structured into a four-year program requiring a significant number of staff for both theoretical and practical training, offers limited opportunities for improving the management of educational costs ( 2 ). It is suggested that when a dental school is effectively managed within its budget and aligns with the mission and objectives of the university, its costs become acceptable to the institution. Importantly, the value of a dental school should not be solely measured by its costs, but also by the quality of education, research, services, and the impact of graduates on community health ( 4 ). Although the number of dental graduates continues to increase, evidence suggests that the proportion of the population who regularly visit dentists for routine treatments is decreasing. While more dentists are trained, patient treatment frequency has declined, with dentists compensating for this by raising fees. To address this issue, hospital-affiliated medical schools and medical groups are being considered as a solution. These institutions could train more students and increase graduate numbers at a lower cost through economies of scale, as expanding capacity does not necessarily double running costs ( 5 ). Moreover, the cost of dental education should not merely be viewed as an expense but as an investment. This perspective requires assessing costs in terms of time, money, and the expected return on investment ( 8 ). The present study estimates that the average cost of educating a general dentistry student at Iran University of Medical Sciences in the 2022-23 academic year is $132,438 (PPP). A significant portion of this cost (61%) is attributed to human resources, followed by consumables (20%) and equipment depreciation (14%). These findings indicate that human resource-related expenses are the major cost drivers in dental education. Therefore, financial planning aimed at improving education quality should focus on optimizing human resources to increase efficiency and reduce unnecessary costs. In a similar study conducted by Pouragha and colleagues in 2020 at Alborz University of Medical Sciences, the average annual cost of services for each student was $4,778, with 65% of this cost dedicated to wages and salaries, 26% to depreciation of buildings and equipment, and 9% to consumables ( 17 ). Similarly, Rahimniya et al. (2011) estimated the cost of student services at Tehran University of Medical Sciences using ABC and found the full cost of services to be 12,465,916 rials ( 18 ). A study conducted at Mazandaran University revealed that the average cost per student in the Dental and Pharmacy Schools was $8,582 and $5,789, respectively. Faculty salaries and benefits accounted for the highest costs ( 19 ). Doroodi et al. (2020) concluded that the total cost of educating each PhD and Master's student in the Health Management and Economics Sciences group was approximately 433 and 150 million rials, respectively, with 78% of the costs attributed to direct activity centers ( 15 ). Rezaei and associates (2022) estimated the cost of educating each medical student at AJA University of Medical Sciences to be 6,267,568,065 rials, noting that the underutilized capacity in overhead and intermediate centers was 30% and 33%, respectively ( 16 ). These findings are consistent with the results of this study when adjusted for inflation. In a study by Tabriz University of Medical Sciences, personnel costs represented 74% of the total student training costs ( 20 ). Other studies, such as one by Namazi et al., showed that educational costs in general represent about 70% of total student education costs, with various factors such as the number of students per major, education level, and field of study influencing these costs ( 22 ). The use of Activity-Based Costing (ABC) has proven useful in identifying the root causes of rising higher education costs. Given the high proportion of personnel costs, strategic planning around human resource management and addressing underutilized faculty members could improve efficiency and productivity ( 23 ). Furthermore, the growing demand for tools that assist in managerial decision-making, driven by increased competition among universities and regulatory requirements, highlights the need for clear, measurable cost-effectiveness indicators. Universities, being among the largest public institutions, face unique challenges in cost recording due to the diversity of their activities. The increasing demand for detailed cost information makes the implementation of management support tools, such as ABC, essential ( 24 ). ABC helps track the costs associated with each activity based on its frequency or demand, leading to more accurate evaluations of budgetary issues and financial allocations, and ultimately improving financial management within universities ( 23 ). Personnel costs, especially payments to faculty members, and capital expenditures are the largest financial burdens in higher education. A study has shown that the high cost of dental education places a substantial financial burden on students, particularly those from lower socioeconomic backgrounds, with a significant portion of these expenses allocated to accommodation costs ( 4 ). To mitigate these challenges, innovations such as digital delivery of theoretical courses and more efficient use of facilities could reduce dependence on shared resources, lower administrative costs, and minimize faculty salary expenses. The COVID-19 pandemic demonstrated the feasibility of remote learning, which can reduce costs associated with traditional in-person courses ( 25 - 27 ). This study is limited to the cost analysis of educational activities only. Costs associated with human resources and equipment used in patient care and income-generating activities were not included. Additionally, it was not possible to separate depreciation costs for buildings and equipment associated with therapeutic services. In conclusion, the study findings indicate that personnel costs represent the most significant portion of overall educational expenses. Improving human resource productivity should be a top priority for dental schools. Furthermore, consumable costs are notably high. By leveraging ABC, dental schools can gain a clearer understanding of cost patterns, enabling more effective financial management and resource allocation. Future research could explore the cost differences between theoretical and practical training, as well as the role of technology in reducing dental education costs. Table 3. Direct costs per cost center and share of overhead costs ($PPP) Type of Centers Activity centers Depreciation cost of building Depreciation cost of equipment Personnel costs Supplies Utilities Direct (specific) cost Allocation base Value of Allocation base The overhead share of each unit to other units Head office 6,143 2,936 33,268 34,264 540 77,151 Employees + Students 137 563 facilities and technical office 498 23,821 66,535 68,226 276 159,356 Area 3,450 46 network room 111 2,527 - 8,566 8 11,211 Employees + Students 137 82 warehouse and boiler room 2,767 686 66,535 17,132 431 87,552 Employees + Students 137 639 water station 1,328 514 66,535 8,566 333 77,277 Employees + Students 137 564 Overhead lobby and public space 34,287 1,194 - 4,283 2,336 42,100 Employees + Students 137 307 prayer room 415 465 - 2,141 28 3,050 Employees + Students 137 22 administrative affairs 415 1,234 33,268 25,271 149 60,338 Employees + Students 137 440 electrical room 166 62 - 1,071 11 1,310 Area 3,450 0 Guard unit 249 200,504 33,268 10,172 138 244,331 Employees + Students 137 1,783 accounting 166 2,052 20,456 4,074 132 26,880 Employees 50 538 Supply Unit 249 852 20,456 2,855 138 24,551 Employees 50 491 security 166 310 61,368 6,309 375 68,527 Employees + Students 137 500 information technology educational department 249 972 20,456 4,203 138 26,018 Employees + Students 137 190 498 831 107,858 7,487 397 117,072 Students 87 1,346 Intermediate medical equipment 249 268 20,456 13,741 138 34,852 Students 87 401 Admission 692 1,139 81,823 3,993 531 88,179 Employees + Students 137 644 changing room and dining area 2,491 2,015 - 2,496 170 7,171 Employees + Students 137 52 occupational health 277 1,674 20,456 2,995 140 25,541 Students 87 294 library and study hall 775 3,300 17,183 3,744 174 25,175 Students 87 289 suction room 111 738 - 5,615 8 6,471 Students 87 74 compressor room 111 465 - 9,359 8 9,942 Students 87 114 general practitioner 830 208 53,647 7,487 662 62,834 Students 87 722 radiology 3,016 5,845 34,367 7,693 448 51,369 Students 87 590 Class 3,404 643 - 2,063 10,826 16,936 Students 87 195 CSR 2,767 10,184 - 27,504 189 40,644 Students 87 467 plaster room 1,273 1,697 - 6,188 87 9,246 Students 87 106 Final unit hall 19,925 26,026 103,101 33,005 1,600 183,656 Students 87 2,111 pathology 2,491 1,050 - 22,462 170 26,172 Students 87 301 diagnostics 2,214 1,400 17,183 18,250 272 39,319 Students 87 452 restorative phantom 2,491 11,173 - 8,251 170 22,085 Students 87 254 darkroom 111 697 - 4,126 8 4,941 Students 87 57 educational groups 4,538 20,456 600,762 111,604 2,125 739,485 Students 87 8,500 Whole school 95,472 327,939 1,478,981 495,197 23,153 2,420,741 Open in a new tab Acknowledgments The authors would like to express their sincere gratitude to the Vice President of International Affairs at Iran University of Medical Sciences for their approval and support of this research project. 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