Dentistry - a professional contained career in healthcare. A qualitative study of Vocational Dental Practitioners' professional expectations

How and why do health system factors influence general dentists' participation in publicly funded, contracted primary dental care services: A realist review

OBJECTIVES

To identify health system contexts and mechanisms influencing general dental practitioners' (GDPs) participation in state funded, contracted primary oral healthcare.

METHODS

Peer-reviewed articles and other sources were identified via EMBASE, Medline (OVID), Web of Science and Google Scholar databases, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour, relevance and richness, and coded to identify data relating to contexts, mechanisms and outcomes. Inductive and deductive coding was used to generate context-mechanism-outcome configurations (CMOCs) and develop the final programme theory.

RESULTS

Database searching identified 1,844 articles of which 29 were included. A further 33 sources were identified through adjunctive searches. Analysis identified key systems contexts influencing GDP participation. These include system emphasis on treatment over prevention, low priority for oral healthcare, funding constraints, and change implementation with minimal clinician consensus. At operational level, contracts can restrict GDP decision-making and ability to deliver high quality and holistic patient care. Key underlying mechanisms were feelings of ceded clinical and entrepreneurial control, stress and demoralisation, mistrust of the system and feeling undervalued.

CONCLUSIONS

The factors influencing GDP participation in state-funded, contracted dental care over private dental care are complex. The findings presented in this review have the potential to act as a good place to start leveraging health system change including better GDP engagement and increase participation in publicly funded systems.

Dental careers: findings of a national dental workforce survey

Aim To explore dentists' experiences of their professional careers and job satisfaction within the United Kingdom (UK) workforce.Methods A cross-sectional survey of the national dentist workforce was conducted using an online questionnaire, informed by previous research. The anonymous online survey was conducted between February and May 2021, with ethical approval, via national gatekeeper institutions, and promoted through social media. Statistical analysis of the data was performed in SPSS.Results Of the 1,240 respondents, 875 had completed 96% of the questionnaire, including providing demographic details, and were included for analysis. Almost half (46%) reported their career was 'not as envisaged'. A majority (58%) of dentists reported that their career plans had changed and 40.2% reported planning on changing careers. Significant associations were found between an individual's career plan trajectories ('as envisaged', 'changed plan' and 'planning on changing') and sex, ethnicity, job satisfaction, primary role settings, country qualification was obtained and duration of working experience. Men were significantly more likely to report their career was as envisaged. Job satisfaction was higher for those whose careers were as envisaged and had no plans for future changes.Conclusions Careers were not necessarily as envisaged, with over half of the dentists surveyed changing their career plans over their working life. There was greater satisfaction among those whose careers were envisaged and had experienced career progression..

The impact of virtual reality haptic simulators in pre-clinical restorative dentistry: a qualitative enquiry into dental students' perceptions

PURPOSE

In the realm of restorative dentistry, the integration of virtual reality haptic simulation (VRHS) for learning operative skills has garnered varied perceptions among dental students. Therefore, the aim of this study was to delve deep into undergraduates dental students' perceptions related to the impact of VRHS in pre-clinical restorative dentistry.

METHODS

A homogeneous purposive sampling method was utilized to gather data from third-year undergraduate dental students (n = 23) at the College of Dental Medicine, Qatar University, to thoroughly investigate their views on the impact of VRHS on their learning experience in preparing a standard class I cavity. An explorative qualitative method using face-to-face focus group sessions were conducted in English during 2023. Focus group sessions were recorded and transcribed using Microsoft Teams. Two authors independently read the transcripts, coded the text, and manually analyzed text using an inductive thematic approach.

RESULTS

A total of 21 (91.3%) students participated in this study. Analysis of 3 focus group interviews revealed five primary themes summarized with the term "MASTR" (M = manual dexterity, A = assessment, S = sequence, T = training, and R = realism). Based on frequency of reported themes, students perceived realism/ lifelike nature of VRHS requiring further enhancement to achieve the desired learning objective.

CONCLUSION

Although, VRHS play a crucial role in modern dental education, offering innovative solutions for training, evaluation, and feedback, the need to enhance their ability to simulate real-life dental procedures and learning environment (realism), coupled with interactive and immersive learning experiences were the most frequently raised theme by students. In terms of curriculum design and learning pedagogies, dental educators should consider the appropriate sequence when integrating VRHS within the undergraduate curricula.

Unveiling motives for dentistry studies: psychometric validation of a comprehensive questionnaire among aspiring dental students

OBJECTIVE

The aim of this study is to develop and validate a questionnaire for dental students in Ecuador to assess their reasons to study dentistry.

MATERIALS AND METHODS

A 25-item questionnaire was developed by the authors based on similar studies and a qualitative study. The questionnaire had five theoretical factors: economic, professional, vocational, social and academic reasons for study. In the first two samples, exploratory factor analysis was performed to identify the structure, and the models obtained were compared with confirmatory factor analysis in the third sample.

RESULTS

Three samples were used, sample A with 201 participants, sample B with 623 participants, and sample C with 596 participants. Two-thirds of the participants were female and almost one-third were from coast region. The EFA applied in sample A resulted in a five-factor model with 18 items; in contrast, a three-factor model was obtained from sample B. According to the CFA in sample C, the best model was explained by three factors: labor, vocational and academic reasons. Considering two items to cross-load in labor and vocational factors, which are theoretically justified.

CONCLUSION

This study presents a 12-item questionnaire that assesses labor, vocational and academic reasons for studying dentistry in an Ecuadorian population.

The Presence of Women in the Dental Profession: A Global Survey

OBJECTIVES

The aim of this research was to acquire knowledge about the female dental workforce, identifying factors to pursue specialty training and career choices and working in dental institutions/associations.

METHODS

An original online questionnaire was developed, validated (n = 22), and sent to 189 member associations in 133 countries of the Women Dentists Worldwide section of the FDI World Dental Federation.

RESULTS

In all, 3232 female dentists from 81 countries participated. Results were divided into 5 geographic areas by continent. Difference in proportion amongst questionnaire items was evaluated with χ2 test or Fisher exact test. Ordinal multinomial linear regression analysis was performed to evaluate the association of questionnaire items with total work experience in dentistry (in years), motivation to study dentistry, type of specialisation, working hours per week, perception of female dentists about working hours, sex-based inequalities, job security after maternity leaves, as well as involvement in political organisations within their country of residence and their role in dental associations. A majority of participating female dentists are self-employed (57.7%), and 60.0% have 10 to 30 years of experience. The most popular form of practice is the single private practice (29.7%), followed by the group private practice (28.8%). Further, 44.8% work 31 to 40 h/wk, 29.1% part-time up to 30 h/wk, and 26.0% more than 40 h/wk.

CONCLUSIONS

Women are still poorly represented in professional organisations, and few are officers in representative assemblies, members of the board, or president. Family life with children influences perceptions and has an impact on professional life, especially in academia and political/professional associations, so that taking on leadership positions poses additional challenges.

Journey towards a dental career: the career decision-making journey and perceived obstacles to studying dentistry identified by London's secondary school pupils and teachers

Objective To explore the career decision-making journey towards dentistry and identify possible challenges and supports in this process as perceived by academically able, science-minded, London school pupils and their careers teachers.Methods A mixed-methods study was conducted using a purposive sample of London schools. Focus groups (n = 13) with 91 pupils aged 14-18 years and a survey of career teachers (n = 12) were conducted at a range of school-types. A topic guide, informed by the literature and previous research, guided discussions. Ethical approval was obtained from King's College London Research Ethics Committee (BDM/10/11-17 and 14/15-40). School, teacher, parental and pupil written informed consent were obtained. Data were transcribed and analysed thematically using framework methodology.Results Four distinct phases of the career decision-making journey were identified: 1) initiation of aspiration, with wider influences promoting medicine as a primary aspirational career option; 2) exposure to dentistry as a career, leading to recognition of dentistry as an alternative; 3) exploration of the career; and 4) the application process. Dentistry received little early consideration in this process. Greater representation of dental professionals within the school, access to work experience, and support in the student application process were identified as possible supports.Conclusions The findings suggest a four-phase journey towards a dental career, which may be enhanced by engagement of dental professionals at each stage. This may be particularly helpful in widening participation from under-represented groups.

Flexibility and access to dental postgraduate speciality training

Increasingly, there is a clear emphasis on the need for improved access to flexible training. This reflects changing societal attitudes and expectations towards work-life balance and increasing demand for flexible working. The recently published Advancing dental care review: final report (2021) reflects these same demands within dental postgraduate training. Increasing flexible training options has the potential for far-reaching beneficial effects for dental speciality training. There are barriers to accessing speciality training for specific applicant groups and this risks potentially excluding excellent-quality candidates from pursuing speciality training. There is opportunity in utilising and developing flexible training options to support widening access to dental speciality training. Recruitment and working pattern arrangements should reflect these aspirations, ensuring that the best trainees are successful irrespective of their personal circumstances.

Career satisfaction amongst dental students and dentists in Saudi Arabia: A cross-sectional survey

INTRODUCTION

Dental students' satisfaction with their own career can significantly improve the quality of care provided to patients. The aim of the current study was to assess the level of career satisfaction amongst Saudi dental students and dentists.

MATERIALS AND METHODS

A cross-sectional survey was conducted from October 2019 to January 2020 all over Saudi Arabia. A sample of 750 Saudi dental students and dentists were invited to complete an online questionnaire. The questionnaire was composed of two sections of closed-ended questions. The first section included personal, professional background factors and level of career satisfaction assessed. The second section included different reasons for choosing dentistry as a career. Multivariable linear regression was used at significance <0.05.

RESULTS

Only 674 responded to the questionnaire. About half of the included respondents were males. Most of the participants were undergraduate students attended Saudi dental schools. 72.3% chose dentistry for helping other people. Graduated dentists had significantly lower satisfaction score than dental students (p = .007). Dentists, who chose dentistry because it is a secured job with good income (p < .001), had significantly lower satisfaction score than those who did not, whilst those who chose it for the social status had significantly higher satisfaction score than those who did not (p = .04).

CONCLUSION

Dental students and dentists were motivated to choose dentistry as it is an opportunity to help others and achieve good salary with appropriate social position in community. Dental students were more satisfied than dentists due to lack of financial responsibilities and absence of educational expenses.

A qualitative enquiry into dental students' perceptions of dentistry as a career choice in the State of Qatar

BACKGROUND

Career choice is a complex, multifaceted process affecting all aspects of life. Motivational factors of aspiring dentists are crucial to inform institutions and aid with the admission process. The aim of this study was to explore undergraduate dental students' perceived motivation for their career choice in the first dental institution in the State of Qatar to bridge the gap in knowledge in this area.

METHODS

Homogeneous purposive sampling technique was employed to collect data from all year 2 and year 3 undergraduate dental students to gain a deeper insight into their motivation of career choice. An explorative qualitative method using face-to-face focus group sessions were utilized. All focus groups were conducted in English and contained a moderator and observer. A topic guide was used to ensure data collection standardization. Participants' views were recorded and filed notes obtained. Data was transcribed and analysis performed utilizing an inductive thematic approach.

RESULTS

A total of 34 students (89.5%) from year 2 and 3 participated in the focus groups. Data analysis revealed six main themes emerging from this study namely; altruism and patient care, family influence factors, childhood aspirations, hands-on practical skills, professional and social status, and the opportunity to reconsider and transfer. Based on frequency, altruism, opportunities to learn hands-on practical skills and professional status appeared to be the main drivers influencing students' choice of dentistry as a professional career.

CONCLUSION

This qualitative study presents the first national study providing insightful information regarding current undergraduate dental students' decision process in relation to their profession selection, and shows that opportunities to provide patient care seems to be the key to motivation. There was also a strong inclination towards performing hands-on practical tasks as a dentist, and developing a professional status. Interestingly, financial reward did not feature as a motivational factor in this study. The study highlights the influence of socio-cultural and economic factors on choosing dentistry as a career. This data could help dental institutions better understand future applicant's motivations to join dentistry and assist with the academic recruitment/admission process and targeting students with a potential to excel in the profession.

Future expectations, career choices and related factors among dental students: A cross-sectional study

Purpose

The aim of this study was to determine descriptive characteristics of dental students, to investigate their professional expectations, career decision criteria, and related factors; to examine how (if any) seniority in school affects these.

Subjects and methods

During the period of 2018-2019, all 1-5 grade students (n = 754) of Hacettepe University Dental School were invited to participate and those who accepted had filled under observation a standard questionnaire form of 35 questions (83.4%). In the analysis of the data, descriptive statistics, chi-square, Student's t-test and ANOVA and Odds ratio methods were used.

Results

In this cross-sectional study, 66% of the group were female, age range was 18-30 (mean±SD= 21.2 ± 1.7). The most common reasons for choosing dentistry were "financial benefits", "job security" and "professional status". "Undertake specialist training" (80.2%) was the most common short-term expectation after graduation; two most common long-term expectations were "having a private clinic" (57.9%) and "completing specialization training" (56.0%). The most important factors affecting the post-graduation working plans were work-life balance and economic stability.

Conclusion

It is recommended to provide adequate counseling and guidance to students about potential career paths to maximize a balanced and widely accessible oral health service delivery across the country with more motivated dentists. Qualitative research may improve our understanding of how dental education can be improved to fulfill students' expectations from school, and to motivate dental students towards general practitioning in the future.

Dentistry as a professional career: the views of London's secondary school pupils (2011-2017)

Aim To explore young people's perceptions of dentistry as a potential future career, including features which would attract or deter them from wanting to become dentists and the perceived influences on these views.

Methods Purposive sampling of London schools was undertaken. Exploration of academically-able, science-minded young people's (aged 14-18 years) perceptions of dentistry as a potential career was achieved through a series of focus groups conducted at various types of school in the Greater London region (13 focus groups and 91 students). A topic guide, informed by the literature and previous research, explored the perceived motivating and demotivating factors and associated influences, identified by these pupils, on studying dentistry at university. Data were analysed using framework methodology.

Results Multiple factors were identified by London secondary school pupils that would attract them to dentistry. Pull factors were: 1) science-based; 2) status and security - extrinsic rewards; 3) structure of service provision; 4) career opportunities; 5) social interactions; 6) personal skills and care - intrinsic rewards; and 7) being a vocational degree. Push factors away from the career included lack of diversity within the job and the 'negative image' of dentists, with medicine having greater social status and more varied career options. Individual and wider influences on pupils' perceptions included their personal experience with dentistry, social and community networks, the school environment, as well as system and societal level influencers.

Conclusions These findings suggest that a wide range of influences determine teenagers' perceptions of a dental career. Pupils in London schools report similar features of dentistry as being attractive as dental students, as well as its importance as a vocational degree, and although dentistry appears to lack status and profile when compared with medicine, it may be more acceptable in relation to its lifestyle. Individual sociodemographic characteristics and wider environmental factors may influence the relative importance of these features.

Provides a greater understanding of the features of a career in dentistry that attract/deter young people to/from this career early in their decision-making process.

Explores how these perceptions may be influenced by individual characteristics.

Describes the importance of the environmental context in influencing these perceptions.

Influence of Oral Health Care Systems on Future Career Environment of Dental Students in Europe

Oral healthcare is organized subsidiarily and independently by nation states in Europe and also within the EU and consequently, major differences between the nation states and the various oral healthcare systems in Europe are present. The socialization in the respective catchment area can have an impact on the job choice and the perception of employment opportunities of different professional groups. Therefore, the purpose of this survey was to elucidate the influence of different oral healthcare systems on students living or studying in the respective catchment area. A questionnaire (in English, French, German, Italian, and Spanish) with 18 different components was administered. Data on gender, age, country of origin, university, semester, nationality, expected time of graduation, and forecast for future professional practices were gathered. In addition, 3851 students participated (2863 f/988 m). The sample distribution was uneven with predominantly Bismarckian and Southern European System participants. The National oral health care system was statistically significantly linked (p < 0.01) to the ownership period of a dental practice. Students in Bismarckian and Nordic systems tended to find their own practice earlier than in the Beverdigian system or Southern European and Transitional-East European systems. An association between the oral health care system and vocational training was inhomogeneous, but also significantly different (p < 0.01). The majority (47.51%, n = 1555) would like to work in their own practice, 18.95% (n = 621) want to establish a practice with two or more owners. It was striking that no student would like to work in the investor practice/practice chain of both Nordic, Beveridgian and Transitional-East European countries systems (p < 0.01). The oral health care system in which a dental student grows up/resides/studies influences the career choice/perception of future professional practice.

Reaching A Female Majority: A Silent Transition for Dentistry in the United Kingdom

This paper highlights the process of transition to a female majority for dentistry, examines various influences on this trajectory, and considers the implications for the profession, health systems and patients, as well as individual dentists.This celebratory transition has been facilitated by educational systems that provide both males and females with equal opportunities and is supported by legislation, as well as societal change that has spanned decades. In crossing this gender representation threshold, we have outperformed doctors nationally.In order to embrace our highly educated workforce and support them to better serve their patients and the population, urgent debate and action aimed at reshaping current systems of dental care provision are required. In this regard, flexible working arrangements, together with reshaping professional leadership to better represent the workforce, as well as changes in terminology can all play their part; however, we will need careful discussions about how this might happen effectively.A collaborative effort between the dental profession and wider health systems is required to ensure that there are opportunities for everyone to flourish and contribute back to the profession and society. Our medical counterparts have been considering how healthcare should be shaped creatively, particularly in relation to working patterns, economic models and quality patient care: we need to catch up.

Gender Differences in Work Status during Early Career of Dentists: An Analysis of National Survey Cohort Data of 10 Years in Japan

Few studies have evaluated gender differences in young dentists’ career focusing on career breaks and return to work. We created a cohort dataset for dentists registered in 2006 using the national survey between 2006–2016 (men, 1680; women, 984), and examined the work setting of dentists by gender 10 years after registration. The proportion of dentists on career break increased each survey year, and was more pronounced in women than in men (2006 to 2016, men, 11.2% to 14.2%; women, 7.9% to 31.0%). The proportion of those who had career breaks between 2006–2016 was 44.8% in men and 62.9% in women. In the multiple logistic regression for examining the associations between those who returned to work compared to those working continuously, in women, the odds ratios (OR) were significantly higher in those working in dental clinics (owner, OR: 5.39; employee, OR: 3.10), and those working part-time (OR: 2.07); however, in men, there was no significant association with part-time work. These results suggest during early career phase, female dentists are more likely than males to take career breaks and choose part-time on returning. These gender differences should be considered for ensuring adequate workforce in dentistry in the future.

Expectations Regarding Dental Practice: A Cross-Sectional Survey of European Dental Students

Obtaining information on expectations among dental students regarding their career planning was the main purpose of this observational online survey. The questionnaire was designed with 18 items in five different languages: English, French, German, Italian and Spanish. Data were collected on nationality, age, sex, country of residence, university attended, semester, expected year of graduation and expectations about future career. More than 3000 participants (n = 3851, 2863 females 74.34% and 988 males 25.66% with a sex ratio of 0.35) participated in the survey. Almost one-third (31.29%) of the participants plan to start their own practice at least three years after vocational training, a quarter (25.76%) after three, and only 12.59% after one year. A positive influence of the family in the decision to start a practice was observed in 50.07% of the sample with a statistically significant difference regarding sex (p < 0.01). Almost one-third of the participants did not wish to work in an institution run by private equity or insurance companies, while 21.79% would work in that environment (p < 0.01). European dental students desire mainly to become self-employed and start their own practice. New professional practices also offer them options for their future career that they have not yet decided on or thought about.

Motivation to Follow a Career in Dentistry of Students in Three South-East European Countries

Objective

To investigate and compare the factors that motivated students to study dentistry in countries with similar background (Albania, Croatia and the Republic of Northern Macedonia) and to assess whether or not their motivation changed during time.

Material and methods

In 2014/2015, cross-sectional studies were conducted in state funded dental schools in Tirana (Albania), Zagreb (Croatia) and Skopje (Macedonia) to assess student views on their career motivation. All dental students from the first, third and final years of study were invited to participate. The participation was voluntary and anonymous. A five-item questionnaire was translated into languages of the participating countries. Ethics approval was granted by the Ethics Committee of the University of Saints Cyril and Methodius, Skopje. The Chi square test was used to test if there were statistically significant differences in answers between students in 3 countries, furthermore between years of the study.

Results

The total number of respondents was 739 (319 in Tirana, 211 in Zagreb and 208 in Skopje) The differences in the answers between the first-year students from all three countries were statistically significant (χ²=82.65; p<.01). The most striking answer was to the question on parents' pressure to study dentistry, which was far more frequent in Tirana (up to 27.7%). A "positive image" was the most frequent response from students from Zagreb (up to 79.7%), but it declined from the first to the final year in Skopje. There were also significant differences between the schools within the 3^rdand final years of study.

Conclusions

A positive image of dental profession was the main reason for students studying dentistry at all three schools; as many as 97% of the students of the final year in Croatia, a member of the European Union (EU). In the two non-EU countries (Albania, Macedonia) it seemed that dental profession does not have such good status and student expectations are not being fulfilled, especially in Skopje (up to 33.9% willing to change their vocation and up to 64.5% lost their motivation to study) One of the strategies to improve the situation could be to include more clinical practice and to better organize the study..

Career Prospects of Young Dentists in Switzerland

The observational cross-sectional study was aimed to obtain information on the promotion and development of young professionals in Switzerland. An online survey with 20 questions was sent out. Data was collected on participants’ demographic data, including age, gender, level of qualification, place of work, information on employment, future perspectives, and career prospects. The survey was sent out to 1920 practitioners, of which 440 (22.9%) responded (37.1% males and 62.9% females). Of them, 76.6% were members of the Swiss Dental Association (SSO) 15.9% students, and 7.5% non-SSO members. Most participants had parents with a dental education (80.9%), and 19.8% did not. Young dentists in Switzerland most often saw their career prospects as neutral (39.8%) or rather positive (39.3%). Whereas significantly fewer dentists had a negative view of their professional future (16.8%), including more women than men, the fewest dentists of both sexes (4.1%) saw their career prospects as positive by far. The majority of young dentists were satisfied with their career prospects. Within the limitations of the current study, the reasons for this need further investigation. Despite good career prospects, there is a desire among young colleagues for cantonal practice assistance and mentoring programs, as well as support in finding a job and in taking the plunge into self-employment.

The dental workforce in Malaysia: drivers for change from the perspectives of key stakeholders

OBJECTIVE

The dental workforce is facing unprecedented change globally as a result of multiple influences. There is a need for research informed action to map possible drivers for change at the national level and examine their potential implications in order to shape the dental workforce to serve population needs. The objective of this study was to explore key stakeholders' views on the drivers for change for the Malaysian dental workforce and their potential implications.

METHOD

Stakeholders from key dental organisations/professions in Malaysia were purposively sampled and invited to participate in a semi-structured interview (n = 20) using a pre-tested topic guide. Interviews were recorded, transcribed verbatim and analysed using Framework Analysis.

RESULTS

Drivers for workforce were identified across four main domains: policy-politics; trends in demography; social and economic; and, technology-scientific development. The pace of change and possible interplay between drivers, most notably government policy, liberalisation of education and health services and challenges of workforce governance, followed by Malaysian demography and health trends. Implications for the future, including possible uncertainties, particularly in relation to specialisation and privatisation were identified, together in balancing and meeting public health needs/demands with professional career expectations.

CONCLUSION

Stakeholders' views on the high-level drivers for change broadly mirror those of high-income countries; however, specific challenges for Malaysia relate to rapid expansion of dental education and a young workforce with significant career aspirations, together with imbalances in the health care system. The impact of these drivers was perceived as leading to greatest uncertainty around specialisation and privatisation of the future workforce.

Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England

Background

To help promote a flexible and sustainable workforce in dentistry, it is necessary to access accurate and timely data about the structure and nature of the evolving dental team. This paper considers the results and learning from a region-wide dental workforce survey conducted in one area of Health Education England and how the team has changed since the last survey a decade earlier.

Methods

A mixed-methods approach comprised two phases. In Phase 1 a customised workforce questionnaire was sent to all dental practices registered with the Care Quality Commission in the North East of England and North Cumbria in March 2016. Findings then informed Phase 2, a regional symposium held in October 2016, where interactive workshops generated qualitative data that elaborated on factors influencing workforce development.

Results

Of 431 primary dental care practices identified, 228 questionnaires were returned - a 53% response rate. The largest professional groups were dental nurses (n = 1269, 53% by headcount; 50% of fte) and dentists (34% by headcount; 42% by fte), though there had been increases in numbers of all staff groups over the decade, which was most marked for dental therapists (from 1 per 39 dentists to 1 per 8 dentists). The dental team predominantly fell into ‘younger’ age groups (< 46 years age), with evidence of a significant increase in the number of dentists reporting part-time working in a practice since the last survey. Around one third of dental practices reported employing dental nurses with additional skills (n = 74, 32.5%) or dental therapists (n = 73, 32%), and nearly half employed a dental hygienist (n = 104, 46%). However, there was considerable variability in whether these staff actually carried out the range of skills within their scope of practice. Factors shaping workforce development were identified as, the national context, loss of expertise, patients’ health needs and expectations, surgery premises and financial constraints.

Conclusions

The composition and work patterns of the primary care dental workforce have changed markedly over the last decade, though utilisation of skill-mix continues to be constrained. Consideration of factors determining career progression of dentists and dental care professionals is needed to optimise a sustainable future workforce.

Key determinants of health and wellbeing of dentists within the UK: a rapid review of over two decades of research

Aim To review the key determinants of health and wellbeing among dentists working in the UK.Methods Rapid review of the literature (1996-2018) across seven health and social science databases through OVID and the Cochrane Library, professional and health system sources. Records were screened according to agreed inclusion and exclusion criteria by title, abstract and full text. Data extraction and qualitative synthesis of the included studies were performed. Quality assessments for risk of bias were made using a mixed methods appraisal tool.Results Thirty-eight studies met the criteria for inclusion. Fourteen were assessed as high, 22 as medium and two of low quality, most involving cross-sectional research in the form of questionnaire surveys. Whereas overall, the health and wellbeing of dentists within the UK is reported as 'good', recently published evidence suggests a less positive view may be emerging. The health and wellbeing of dentists is associated with a wide range of factors: personal, professional career, relationships, job specification, workplace and system. Emerging evidence suggests additional concerns about the regulation of dentistry. Workplace characteristics were most often explored among researchers and reported as being a key issue.Conclusion Evidence highlights multiple determinants of health and wellbeing, most notably related to workplace characteristics; however, while there is a relative lack of well-founded prospective research investigating the nature and direction of the relationships and comparison across UK health systems, there is increasing evidence of health and wellbeing concerns that require further investigation.

Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone

OBJECTIVE

Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building.

MATERIALS AND METHODS

Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research.

RESULTS

Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig's Angina and Burkitt's Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients' predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments.

CONCLUSION

This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.

Enhanced skills in periodontology: evaluation of a pilot scheme for general dental practitioners and dental care professionals in London

Background The need for periodontal management is great and increasing; thus, the oral and dental workforce should be suitably equipped to deliver contemporary care. Health Education London developed a training scheme to extend the skills of dentists and dental care professionals (DCPs).Aim To examine the feasibility of assessing a skill-mix initiative established to enhance skills in clinical periodontology involving the views of patients, clinicians and key stakeholders, together with clinical and patient outcomes in London.Methods This mixed methods feasibility and pilot study involved four parallel elements: a postal questionnaire survey of patients; analysis of clinical logbooks; self-completion questionnaire survey of clinicians; and semi-structured interviews of key stakeholders, including clinicians.Results Twelve of the 19 clinicians participated in the evaluation, returning completed questionnaires (63%) and providing access to log diaries and patients. Periodontal data from 42 log-diary cases (1,103 teeth) revealed significant improvement in clinical outcomes (P = 0.001 for all). Eighty-four percent (N = 99) of the 142 patients returning a questionnaire reported improved dental health; however, responses from hospital patients greatly exceeded those from dental practice. Interviews (N = 22) provided evidence that the programme contributed to professional healthcare across four key domains: 'service', 'quality care', 'professional' and 'educational'. Clinicians, while supportive of the concept, raised concerns regarding the mismatch of their expectations and its educational and service outcomes.Discussion The findings suggest that it is feasible to deliver and evaluate inter-professional extended skills training for dentists and dental care professionals, and this may be evaluated using mixed methods to examine outcomes including clinical log diaries, patient questionnaires and stakeholder interviews. This inter-professional course represents a positive development for patient care using the expertise of different members of the dental team; however, its formal integration to the health and educational sectors require further consideration.

Do high tuition fees make a difference? Characteristics of applicants to UK medical and dental schools before and after the introduction of high tuition fees in 2012

Aim To compare trends in the volume, socio-demography and academic experience of UK applicants and entrants to medicine and dentistry in the UK with university in general, before and after the major increase in university fees in England in 2012.Methods Descriptive trend analyses of University and College Admissions Services (UCAS) data for focused (preferred subject was medicine or dentistry) and accepted applicants, 2010-14, compared with university in general in relation to socio-demography (age, sex, ethnicity, POLAR 2, region) and academic experience (school type). POLAR2 data provide an indication of the likelihood of young people in the area participating in further or higher education.Results In 2012 the volume of applicants to medicine and dentistry fell by 2.4% and 7.8% respectively, compared with 6.6% for university overall. Medical applications remained buoyant and by 2014 had risen by 10.2% from 2010 to 23,365. While dental applications fell in both 2012 and 2013, they had increased by 15.6% to 3,410 in 2014, above 2010 levels. Females formed the majority of applicants, and admissions, with the proportion gaining admission to dentistry in 2014 reaching an all-time high (64%), exceeding medicine (56%), and university in general (56%). Mature admissions to dentistry were at their highest in 2010 (29%) falling to 21% in 2014, compared with 22-24% in medicine. Black and minority ethnic group admissions to university, although rising (24% in 2014), are still less than for medicine (34%) and dentistry (48%). In 2013, just over half of the students admitted to dentistry were from BME groups (51%) for dentistry. Among UK applicants <19 years, over 60% of applicants, and 70% of accepted applicants, to medicine and dentistry are from the top two POLAR2 quintiles representing areas of high participation in education; however, in 2014 there was a notable increase in the proportion of applications from the lower two quintiles to dentistry (19%) and medicine (20%), with a very modest increase in those gaining admission over 2012 (14% of both; cf 10% and 12% respectively).Discussion The findings suggest that the short-term impact of the 2012 rise in fees had a greater influence on the volume and nature of applicants to dentistry than medicine, and that both programmes are gaining in popularity, despite high fees and reduced places. Dentistry remains particularly attractive to Asians, and females, the latter forming an increasing majority of students. While there is some recovery, social inequalities exist and present a challenge for widening participation in the professions.

The risks and benefits of social media in dental foundation training

The use of social media has greatly expanded in the last decade, with widespread use of smartphones, the internet, and other multimedia to enhance learning. There is evidence to suggest that social media has a place in healthcare education, but there is limited research to suggest the effectiveness or use of it in dental foundation training. This paper discusses the risks and benefits of social media and suggests that a better understanding of social media and its role in the development and practice of newly qualified dental professionals could benefit both trainees and trainers.

Professional Aspirations and Cultural Expectations: A Qualitative Study of Saudi Females in Dentistry

The aim of this study was to explore the perceptions of Saudi female dentists and dental students on their motivation for and expectations of a career in dentistry. Twenty-one semistructured interviews were conducted with a purposive sample of Saudi female dentists (postgraduate students, generalists, specialists, academics, and unemployed), along with final-year female dental students from public and private dental schools. A topic guide, informed by the literature and piloted on a representative group of Saudi dentists, was used to guide the discourse. Interviews were recorded, transcribed verbatim, and then analyzed using framework analysis. We found that highly academic achieving females are interested in a prestigious, financially rewarding career in health care that fulfills their family and community expectations of balancing family life with work. Features of the job that facilitate this balance such as regular hours and no on-call were commonly important. A range of professional interests, most importantly specialization and holding academic positions, often involving studying abroad, emerged. Females' movement between sectors, location of work, and practice patterns in this study were shaped by their domestic circumstances. The findings suggest that Saudi females in dentistry aspire to fulfill their interest in a successful, professional, highly prestigious, progressive career while recognizing cultural expectations and maintaining a family-work balance and perceive this is possible through a career in dentistry. Knowledge Transfer Statement: This study makes an important contribution to the knowledge on this topic. The findings can inform decisions made by policy makers on dental education and workforce planning, as well as future dentists who plan to join the dental workforce. It gives insight into the motivation and career expectations of Saudi females in dentistry in light of the current economic and cultural changes, as well as their implication for the dental workforce.

Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries

OBJECTIVES

The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs).

METHODS

The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted.

FINDINGS

Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries.

DISCUSSION AND CONCLUSION

Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

A qualitative study of work-life balance amongst specialist orthodontists in the United Kingdom

OBJECTIVE

To identify factors affecting work-life balance amongst male and female orthodontists in the UK.

DESIGN

A qualitative interview-based study with a cross-sectional design.

SUBJECTS

Specialist orthodontists working in specialist practice and the hospital service in the UK were selected by purposive sampling.

METHODS

In-depth semi-structured interviews were conducted with 18 orthodontic specialists. Interview transcripts were analyzed using Framework Analysis.

RESULTS

Four main themes pertaining to work-life balance in orthodontics were identified: work factors affecting work-life balance, life factors affecting work-life balance, perception and effects of work-life balance and suggestions for managing work-life balance within the profession.

CONCLUSIONS

There was substantial variation in the work-life balance of the orthodontists interviewed in this study; however the majority reported high levels of career satisfaction despite difficulties maintaining a good work-life balance. Whilst there were some clear distinctions in the factors affecting work-life balance between the hospital environment and specialist practice (including additional professional commitments and teaching/training-related issues), there were also a number of similarities. These included, the lack of flexibility in the working day, managing patient expectations, taking time off work at short notice and the ability to work part-time.

Outreach clinical dental education: the Portsmouth experience - a 4-year follow-up study

BACKGROUND

The Portsmouth Dental Academy (UPDA) was opened in September 2010 and was a development from the highly successful School of Professionals Complementary to Dentistry (2004-2010). The aim of the Academy was to provide integrated team education for all dental professionals in a primary care setting. The dental students are on outreach from King's College London, and the dental care professional students are registered at the University of Portsmouth.

OBJECTIVES

To evaluate the dental students response to the residential outreach educational experience at the UPDA.

METHODS

A 49-item questionnaire divided into nine domains that provided both qualitative data and quantitative data were administered at the end of the longitudinal 10-week placement, to four successive cohorts of students in 2010-2014.

RESULTS

A 95% return rate was achieved. Students valued highly the quality of the clinical teaching. Through their experience, they felt they understood fully the role of the dentist in care planning in primary care and felt well prepared for dental foundation training. This educational success is unpinned with successful maintenance factors including a well-organised induction period and giving the students a sense of belongingness, empowerment and autonomy for their personal development as new graduates.

CONCLUSION

Within the limitations of the questionnaire study over the 4-year period, the students were very positive about all the aspects of this residential outreach education at the UPDA but particularly valued the immersion in clinical dentistry and the bridging from dental school to their dental foundation training.

Career expectations and influences among dental students in Malaysia

INTRODUCTION

It is important to understand career expectations of emerging dental graduates if human resources are to be harnessed in support of oral health. The aims of this study were to explore students' career expectations and their perceived influences, and to examine variation according to student and school characteristics.

METHODS

All final-year students registered for 2013/2014 across 11 dental schools in Malaysia were invited to participate in a self-administered questionnaire (n = 530). The instrument explored short- and long-term career expectations, influences and students' background using a mix of open- and closed-ended questions. The chi-square test was used for comparison according to student and school characteristics.

RESULTS

Three-hundred and fifty-six (83%) students, across eight schools, completed the questionnaire. In the short term, undertaking specialist training (46%) was the most commonly cited career goal, and achieving financial stability (79%) was the greatest influence. In the long term, 59% planned to specialise (with a significant difference found according to ethnic group), and 67% considered working full-time, with men significantly more likely to do so than women (P = 0.036). More Malay students (90%) ranked childcare commitments as an important influence on the number of sessions they planned to work per week compared with Chinese students (75%) and Others (74%; P = 0.001). Work-life balance (95%) and high income/financial security (95%) were the main influences on respondents' long-term goals.

CONCLUSION

There was a high level of interest in specialisation and a desire to achieve financial stability and work-life balance in the group of dental students who responded to the survey. Long-term career expectations varied according to student but not according to school characteristics.

Dentists with enhanced skills (Special Interest) in Endodontics: gatekeepers views in London

BACKGROUND

Dentists with a special interest hold enhanced skills enabling them to treat cases of intermediate complexity. The aim of this study was to explore primary dental care practitioners' views of dentists with a special interest (DwSIs) in Endodontics in London, with reference to an educational and service initiative established by (the former) London Deanery in conjunction with the NHS.

METHODS

A cross-sectional postal survey of primary care dentists working across different models of care within London was conducted, with a target to achieve views of at least 5 % of London's dentists. The questionnaire instrument was informed by qualitative research and the dental literature and piloted prior to distribution; data were analysed using SPSS v19 and STATA v12.0.

RESULTS

Six per cent of London's primary care dentists (n = 243) responded to the survey; 53 % were male. Just over one third (37 %; n = 90) were aware of the DwSI service being provided. Most practitioners reported that having access to a DwSI in Endodontics would support the care of their patients (89 %; n = 215), would carry out more endodontic treatment in the NHS primary dental care if adequately reimbursed (93 %; n = 220), and had more time (76 %; n = 180). Female respondents appeared to be less confident in doing endodontic treatment (p = 0.001). More recently qualified respondents reported greater need for training/support for performing more endodontic treatment in the NHS primary dental care (p = 0.001), were more dissatisfied with access to endodontic service in the NHS primary dental care (p = 0.007) and more interested to train as a DwSI in endodontics (p = 0.001) compared with respondents having a greater number of years of clinical experience since qualification.

CONCLUSION

The findings lend support to the concept of developing dentists with enhanced skills as well as ensuring additional funding, time and support to facilitate more routine endodontics through the NHS primary care to meet patient needs. More recently qualified dentists working in London were more concerned regarding endodontic service access, expressed need for training/support for undertaking more endodontic treatment in the NHS primary dental care and a desire to train as a DwSI in endodontics.

Students' motivation to study dentistry in Malaysia: an analysis using confirmatory factor analysis

INTRODUCTION

Malaysia has experienced a significant expansion of dental schools over the past decade. Research into students' motivation may inform recruitment and retention of the future dental workforce. The objectives of this study were to explore students' motivation to study dentistry and whether that motivation varied by students' and school characteristics.

METHODS

All 530 final-year students in 11 dental schools (6 public and 5 private) in Malaysia were invited to participate at the end of 2013. The self-administered questionnaire, developed at King's College London, collected information on students' motivation to study dentistry and demographic background. Responses on students' motivation were collected using five-point ordinal scales. Confirmatory factor analysis (CFA) was used to evaluate the underlying structure of students' motivation to study dentistry. Multivariate analysis of variance (MANOVA) was used to compare factor scores for overall motivation and sub-domains by students' and school characteristics.

RESULTS

Three hundred and fifty-six final-year students in eight schools (all public and two private) participated in the survey, representing an 83% response rate for these schools and 67% of all final-year students nationally. The majority of participants were 24 years old (47%), female (70%), Malay (56%) and from middle-income families (41%) and public schools (78%). CFA supported a model with five first-order factors (professional job, healthcare and people, academic, careers advising and family and friends) which were linked to a single second-order factor representing overall students' motivation. Academic factors and healthcare and people had the highest standardized factor loadings (0.90 and 0.71, respectively), suggesting they were the main motivation to study dentistry. MANOVA showed that students from private schools had higher scores for healthcare and people than those in public schools whereas Malay students had lower scores for family and friends than those from minority ethnic groups. No differences were found by age, sex, family income and school type.

CONCLUSION

Using CFA, this study shows that academic factors were the main motivation to study dentistry in this group of Malaysian students. There were also variations in students' motivation by students' ethnicity and school sector but not by other factors.

Perceptions of Turkish Dentists of Their Professional Identity in a Market-Orientated System

This study explores the perceptions of Turkish dentists of their professional identity and of the effects of market orientation in dentistry. This phenomenological study used a qualitative approach using a group of Turkish dentists, who were selected based on the principle of maximum variation. Four focus groups and 31 in-depth interviews were conducted. Forty-nine dentists were interviewed using a semi-structured form. The data analysis yielded three themes: ( a) dentistry as a business; ( b) dentistry as a profession; and ( c) professional status of dentistry in the health care system and in the community. The participants' statements reflected that the dominance of market mechanisms in dentistry inevitably forces dentists to adopt the characteristics of a businessperson and prevents them from fulfilling the basic requirements of professionalism. All participants explained that with the transformation of the dental care market, dentists have become a cheap labor force and have lost their professional autonomy. Our study has confirmed previous reports pointing out the conflict between dentistry as a profession and dentistry as a commercial operation. The study also showed that in Turkey, as a country experiencing rapid reform processes, dentists' control over their professional practices and identities has decreased.

The effect of a change in selection procedures on students' motivation to study dentistry

BACKGROUND

The aim of this study was to determine whether changes in student selection criteria at The University of Adelaide effected a change in motivation and influencing factors to study dentistry by comparing cohorts.

METHODS

Online questionnaire completed by first-year dentistry students at The University of Adelaide between 1993-1996 and 1997-2005.

RESULTS

All 666 students completed the questionnaire with 647 suitable for analysis. The likelihood of students being motivated for a career in dentistry because it 'fits with family' was greater for the 1997-2005 cohort (OR = 1.68, 95% CI = 1.14-2.49, p < 0.01) than it was for 1993-1996 enrollees, whereas 'status' became less important (OR = 0.47, 95% CI = 0.30-0.73, p < 0.01). Being influenced by a dentist (OR = 2.41, 95% CI = 1.63-3.55, p < 0.001) or a dental employee (OR = 3.19, 95% CI = 0.90-4.85, p < 0.001) was much greater for the 1997-2005 group than it was for the 1993-1996 cohort. Where students came from, parents' level of education and gender were not significant in the multivariate analysis of factors associated with motivation and influences of students' career choice.

CONCLUSIONS

Changes to the selection procedure were associated with increased emphasis on lifestyle factors and the dental profession, but not with the desire to help people or the importance of the work itself in students' decision to study dentistry.

Motivation to study dental professions in one London Dental Institute

INTRODUCTION

While past research has explored dental students' motivation to study, there is limited understanding in the reasons behind career choice for hygienists/therapists and dental nurses. The aim of this study was to investigate simultaneously the views of students of dentistry, hygiene/therapy and dental nursing in King's College London and explore similarities or differences in career choice.

METHODS

All first-year students were invited to the questionnaire survey, exploring motivation to study using a 23-item instrument. Data were analysed using SPSS v18; statistical analysis included one-way analyses of variance and factor analysis.

RESULTS

The overall response rate to the study was 75% (n = 209). Ten out of 23 factors were considered important by more than 80% of respondents, with 'job security' (93.8%), 'desire to work with people' (88%) and 'degree leading to recognised job' (87.5%) being top three. Analysis suggested that 52% of the total variation in motivating influences was explained by four factors: 'features of the job' (26%), 'education/skills' (11%), 'public service' (8%) and 'careers-advising' (7%); at group level 'features of the job' were significantly more important for the direct entrants to dentistry (P = 0.001).

DISCUSSION

The findings suggest that across groups students were motivated to study by common influences reflecting altruistic, but also pragmatic and realistic motives, while 'features of the job' were more important for the direct entrants to dentistry.

Short and long-term career plans of final year dental students in the United Arab Emirates

Background

New dental schools have been established to train dentists in many parts of the world. This study examines the future dental workforce from the first dental school in the United Arab Emirates [UAE]; the aim of this study was to explore the short and long-term career aspirations of the final year dental students in the UAE in relation to their demography.

Method

Final year dental students of the Ajman University’s College of Dentistry (n=87) were invited to participate in a self-completion questionnaire survey. Descriptive analysis, chi-square tests, and binary logistic regression analysis were carried out on career aspirations using SPSS v20.

Results

Eighty-two percent of students (n=71) responded, the majority of whom were female (65%; n=46). Ethnicity was reported as: ‘other Arab’ (61%; n=43), ‘Emirati’ (17%, n=12), and ‘Other’ (21%, n=15). In the short-term, 41% (n=29) expressed a desire to work in government training centres, with Emirati students significantly more likely to do so (p=0.002). ‘Financial stability’ (80%; n=57) and ‘gaining professional experience’ (76%; n=54) emerged as the most important influences on their short-term career plans. The vast majority of students wished to specialise in dentistry (92%; n=65) in the longer term; logistic regression analysis revealed that the odds of specialising in the most popular specialties of Orthodontics and Oral and Maxillofacial Surgery were less for the ‘Other’ ethnic group when compared with ‘Emirati’ students (0.26; 95% CI 0.068-0.989; p=0.04). Almost three-quarters of the students overall (72%; n=51) intended to work full-time. ‘High income/financial security’ (97%; n=69), ‘standard of living’ (97%; n=69), ‘work/life balance’ (94%; n=67), and ‘professional fulfilment’ (87%; n=62) were reported by the students as the most influential items affecting their long-term professional career choices.

Conclusion

The findings suggest that students aspire to make a long-term contribution to the profession and there is a high level of interest in specialisation with a desire to achieve financial stability and quality of life.

Motivation for a career in dentistry: the views of dental students in the United Arab Emirates

OBJECTIVES

To investigate final-year dental students' perceived motivation for choosing dentistry as a professional career at one dental school in the United Arab Emirates (UAE).

METHOD

Final-year dental students of Ajman University (n = 87) completed a questionnaire. Univariate and multivariate analysis of the data were undertaken using statistical software.

RESULTS

A response rate of 82% (n = 71) was achieved, 65% of whom were female. Students ranged from 21 to 29 years of age. Motivation to study dentistry was led by a 'desire to work in health care' (93%), 'wish to provide a public service' (88.7%) and because 'degree leads to a recognised job' (84.5%). Males were significantly more likely to report 'high income' (84% vs. 67%; P = 0.01) and females 'influence of family' (80% vs. 60%; P = 0.02) as motivating influences. The reliability and internal consistency of the instrument as calculated by Cronbach's alpha was 0.82. Eight factors explaining the 71% of the variation were: 'professional job factors' (11.7%), 'experience and advice' (9.8%), 'business and financial with independence' (9.7%), 'careers, advice and possibilities' (8.9%), 'knowledge and job security' (8.8%), 'health care, people and public service' (8%), 'family and friends' (7.2%) and 'career in dentistry' (6.9%). Gender was a significant predictor of 'business and financial' factor (b = -0.76; P = 0.003) and age for 'careers in dentistry' (b = -0.18; P = 0.03).

CONCLUSION

Students are motivated by a wide range of factors similar to those found in other studies; however, business features and family influences were significantly associated with gender.

British pharmacists' work-life balance – is it a problem?

Objectives

Using a validated tool, the study aimed to explore pharmacists' experiences of maintaining work/life balance in a large, nationally representative sample of pharmacists in Great Britain (GB).

Methods

A two-page postal questionnaire was sent in 2008 to all GB-domiciled pharmacists who were registered with the regulatory body for pharmacy in GB (just over 44 000 pharmacists). Demographic information, work patterns and other employment data were collected and analysed using regression techniques to explore the link between these characteristics and a validated measure of work/life balance.

Key findings

The response rate to the census was 69.6% (n = 30 517). Eighty-three per cent (n = 25 243) of respondents were working as a pharmacist and were therefore eligible to complete the work/life balance statements. The results reported here relate to 12 364 individuals who had full data for the work/life balance scale and the demographic and work variables. Findings indicate that age, ethnicity, having caring responsibilities, sector of practice, hours of work and type of job are significant predictors of work/life balance problems.

Conclusions

Pharmacy employers and government should recognise the changing demographic characteristics of the profession and consider what support might be available to the workforce to help alleviate work/life balance problems being experienced by certain groups of pharmacists.

Self-perceived work preparedness of the graduating dental students

OBJECTIVES

The primary goal of dental education is to prepare students to work independently in a dental practice setting following graduation. Whilst academicians assess students' work preparedness through examinations and evaluations, it is equally important to understand the work preparedness as perceived by students.

METHODS

All students in their final year of the graduate programme in dentistry were selected for this study. The questionnaire assessed the self-perceived confidence in skills and awareness needed to integrate into a general dental practice. Personal data such as gender, age and income status were optionally recorded. The questionnaire included open-ended questions relevant to the educational experiences and suggestions for improvement from student perspective.

RESULTS

Sixty-three students (81.9%) responded to the questionnaire. The majority of the respondents (85.7%) perceived that their education had prepared them well for a career in dentistry, and 52.4% of the students considered that the combination of community placement and in-house training helped them to enhance clinical skills. Students' suggestion for improvements indicated that a large number would wish for more clinical sessions (71.4%), whilst only 28.6% preferred an equal distribution between general clinical placements, speciality clinical placement and didactic teaching as the essential factors in attaining competency.

CONCLUSIONS

Analysing and understanding the student's self-perspective on their dental education and work preparedness contribute towards the quality management of the dental curriculum philosophies: in holistic patient health care, lifelong learning, integration knowledge and skills, leading to the ultimate goal of clinical proficiency.

Collegial Support and Community with Trust in Swedish and Danish dentistry

OBJECTIVES

The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust).

METHODS

A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models.

RESULTS

A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust.

CONCLUSION

A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

The graduate entry generation: a qualitative study exploring the factors influencing the career expectations and aspirations of a graduating cohort of graduate entry dental students in one London institution

Background

Dentistry in the UK has a number of new graduate-entry programmes. The aim of the study was to explore the motivation, career expectations and experiences of final year students who chose to pursue a dental career through the graduate entry programme route in one institution; and to explore if, and how, their intended career expectations and aspirations were informed by this choice.

Method

In-depth interviews of 14 graduate entry students in their final year of study. Data were transcribed verbatim and analysed using framework analysis.

Results

There were three categories of factors influencing students' choice to study dentistry through graduate entry: 'push', 'pull' and 'mediating'. Mediating factors related to students' personal concerns and circumstances, whereas push and pull factors related to features of their previous and future careers and wider social factors. Routes to Graduate Entry study comprised: 'early career changers', 'established career changers' and those pursuing 'routes to specialisation'. These routes also influenced the students' practice of dentistry, as students integrated skills in their dental studies, and encountered new challenges.

Factors which students believed would influence their future careers included: vocational training; opportunities for specialisation or developing special interests and policy-related issues, together with wider professional and social concerns.

The graduate entry programme was considered 'hard work' but a quick route to a professional career which had much to offer. Students' felt more could have been made of their pre-dental studies and/or experience during the programme. Factors perceived as influencing students' future contribution to dentistry included personal and social influences. Overall there was strong support for the values of the NHS and 'giving back' to the system in their future career.

Conclusion

Graduate entry students appear to be motivated to enter dentistry by a range of factors which suit their preferences and circumstances. They generally embrace the programme enthusiastically and seek to serve within healthcare, largely in the public sector. These students, who carry wider responsibilities, bring knowledge, skills and experience to dentistry which could be harnessed further during the programme. The findings suggest that graduate entry students, facilitated by varied career options, will contribute to an engaged workforce.

Measurement of social support, community and trust in dentistry

BACKGROUND AND AIM

Relationships among people at work have previously been found to contribute to the perception of having a good work. The aim of the present paper was to develop scales measuring aspects of social support, trust, and community among dentists, and to evaluate psychometric properties of the scales.

MATERIAL AND METHODS

In 2008, a questionnaire was sent to 1,835 general dental practitioners randomly selected from the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Principal Component Analysis was applied to 14 items and scales were established based on the resulting factors. Internal consistency was evaluated by Cronbach's alpha. Differential Item Functioning (DIF) with respect to gender, nationality and employment sector was analysed using ordinal logistic regression methods. Construct validity was assessed in relation to self-rated health and a range of work satisfaction outcomes.

RESULTS

The percentage of missing values on the items was low (range 0.7%-3.8%). Two scales (range 0-100) were established to measure 'Community with Trust'(nine items, mean = 79.2 [SD = 13.4], Cronbach's alpha = 0.89) and 'Collegial Support'(five items, mean = 70.4 [SD = 20.8], Cronbach's alpha = 0.89). DIF of only minor importance was found which supported cultural equivalence. The two scales were weakly positively correlated with each other. 'Community with Trust' was in general more strongly correlated with work satisfaction variables than 'Collegial Support' was.

CONCLUSIONS

Stability and internal consistency of the scales were considered as satisfactory. Content validity and construct validity were considered as good. Further validation in other populations is recommended.

Attitudes of Irish dental graduates to vocational training

INTRODUCTION

Vocational training (VT) is a mandatory 12 month period for UK dental graduates after graduation. Graduates of Irish Dental Schools are eligible to enter the general dental service in Ireland or obtain an NHS performers list number in the UK immediately after qualification. Reports would suggest that some graduates of Irish Dental Schools are choosing to take part in VT in the UK and find the experience beneficial. This study aimed to record the uptake of VT amongst recent graduates from University College Cork and to document their experiences. It was designed to compare the attitudes and experiences of graduates of Irish Dental Schools who undertook VT compared with those who entered the general dental service.

METHOD

A self-completion questionnaire was distributed by e-mail to dental graduates from University College Cork who had graduated 2001-2007. Responses were returned by e-mail or post.

RESULTS

The response rate was 68.9%. There has been an increase in the numbers of graduates taking part in VT each year since 2004. 92.5% of Vocational Dental Practitioners (VDPs) found their experience beneficial as they received a guaranteed source of income, had a supportive peer network and worked in a positive learning environment. However, some felt that they earned a lower income than their associate colleagues, others found the pace of practice slow and that the duration of the training period was excessive. Eighty-five per cent of VDPs would choose the same position again after graduation as compared with 61.8% of associates (P < 0.001). Ninety per cent of VDPs would advise current undergraduates to take part in VT as compared with 51% of associates (P < 0.001). A larger proportion of VDPs had taken part in postgraduate studies but there was no significant difference between the two groups.

CONCLUSIONS

Larger proportions of recent graduates are undertaking vocational training.--The majority of VDPs and associates find their initial employment position beneficial.--VDPs benefit from a guaranteed source of income, a supportive peer network and a positive learning environment.--Some associates suffered from a lack of support, feeling isolated and overwhelmed with patients.--The majority of previous VDPs and associates would recommend VT to current undergraduates.--Almost 40% of associates would now choose to take part in VT if given the opportunity.