Sultanate of Oman: building a dental workforce

Provision of oral healthcare services in WHO-EMR countries: a scoping review

Global neglect of oral healthcare services (OHCS) provision, mainly in Low- and Middle-Income Countries, exacerbates the deterioration of health systems and increases global health inequality.ObjectivesThe objective is to explore the profiles of available oral healthcare services in the WHO Eastern Mediterranean Region (EMR) countries.MethodsA systematic literature search was conducted of grey literature and databases (PubMed, Medline, Embase, and the Cochrane Library). Peer-reviewed articles that reviewed and/or evaluated OHCS in WHO-EMR countries were identified. No time or language limitations were applied. Two independent reviewers conducted the screening and data extraction. A third reviewer arbitrated disagreement. The evaluation of the OHCS provision followed the WHO framework for health system performance assessment. The extraction included socio-demographic characteristics of the studied population, OHCS profile, responsiveness, and health insurance coverage.ResultsOne hundred and thirty-seven studies were identified. The studies that met the inclusion criteria were fifteen published between 1987 and 2016. In addition, two reports were published in 2022. The included studies were conducted in Pakistan, Saudi Arabia, Iran, Libya, Egypt, Oman, Syria, Jourdan, Kuwait, and Tunisia. Generally, Ministries of Health are the main providers of OHCS. The provision for national dental care prevention programmes was highly limited. Furthermore, most of these Ministries of Health have struggled to meet their local populations' dental needs due to limited finances and resources for OHCS.ConclusionsOral and dental diseases are highly prevalent in the WHO-EMR region and the governments of the region face many challenges to meeting the OHCS needs of the population. Therefore, further studies to assess and re-design the OHCS in these countries to adapt dental care prevention into national health programmes are crucial.

Analysis of Trends in Demographic Distribution of Dental Workforce in the Kingdom of Saudi Arabia

Dental professionals are playing an imperative role in the healthcare system. It is important to distribute the dental workforce across the country. Therefore, this study aimed at analyzing the recent distribution of the dental workforce in the Kingdom of Saudi Arabia (KSA) and determining the current dentist-to-population ratio in the KSA. This is a cross-sectional study focused on the dental workforces working in the KSA between 2015 and 2020. Complete data of dentists working in the KSA with different professional ranks were obtained. The data were stratified by gender, professional rank (Saudi and non-Saudi), area of working (13 provinces in the KSA), and sector of working (public and private). A complete list of all dental universities was obtained to identify the increasing number of dental institutes at this current moment. In addition, the dentist-to-population ratio was also evaluated based on the current inhabitant in the KSA and the total dental surgeons. There are a total of 27181 dental surgeons and 8022 dental auxiliaries registered in different specialties as of 2020. Saudi citizens are holding the majority of the posts in both dentist and dental auxiliary categories. The percentage of males and female is slightly higher in dentists and dental auxiliaries, respectively. It also indicated that where most of the dental personnel work in the private sector, dental auxiliaries work in the public sector. Moreover, the highest number of dental workforces is identified in the Riyadh region among all the 13 provinces. Based on the databases, the current dentist-to-population ratio is 1 : 1288.16. In conclusion, the number of dental professionals is ample; however, rural areas lack specialists. Saudi dentists are progressively replacing foreign dentists in different professional ranks working in the KSA.

Factors Influencing the Students’ Perception of Lecturing Skills in Saudi Dental Schools

Introduction:

Students' feedback is vital in improving the teaching and learning process in dental schools across the globe, including Saudi Arabia.

Objective:

This study explores the factors influencing the students' perception of faculty members' lecturing skills in Saudi dental schools. It also determines whether there is any gender difference in their perception of lecturing skills.

Methods:

The exploratory study design was utilized to evaluate the factors influencing the dental students' perception of lecturing skills at the selected Saudi dental schools (n=4). This study included the complete student population (n=530) of the undergraduate dental program at those schools during the academic year 2020-2021. A questionnaire titled “Students Survey of Lecturing Skills (SSLS)” was distributed to the students through an online tool. The data of the completed questionnaires (n=426) was subjected to statistical analysis using statistical software.

Results:

The structural equation modeling (SEM) analysis revealed that five factors of SSLS, namely, Organization and Structure of the lectures (OS)”, “Lectures Effectiveness on Learning and Understanding (LEL)”, “Interest and Motivation (IM)”, “Professional Interaction (PI)”, and “Presentation and Classroom Atmosphere (PC)” are vital to evaluate the dental students' perception towards lecturing skills. Also, these five factors have significantly influenced the students' perception of faculty members' lecturing skills in Saudi dental schools. Overall, female dental students are highly satisfied than the male students in regard to their faculty members' lecturing skills.

Conclusion:

OS, LEL, IM, PI, and PC are the significant factors influencing dental students' perception of lecturing skills. These factors can be considered while assessing teaching quality and framing effective strategies for enhancing it at Saudi dental schools.

Workforce Planning Models for Oral Health Care: A Scoping Review

BACKGROUND

For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning.

METHODS

A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted.

RESULTS

A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand.

CONCLUSIONS

This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served.

KNOWLEDGE TRANSFER STATEMENT

Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.

Assessing the Students’ Perception of the Quality of Dental Program offered in Saudi Arabia

Background:

In Saudi Arabia, dental students' program evaluation is highly focused on improving dental education quality, so that an effective workforce could be developed for the nation.

Objective:

This study aims to assess the students' perception of the quality of dental program offered at Saudi dental schools.

Methods:

All final year students of the selected Saudi dental schools (N=4) were included as the population of this study. The students were administered a questionnaire named “Dental Program Evaluation Survey.” The survey consisted of four dimensions, with 31 Likert scale items and one global item studying the dental students' satisfaction towards the programs offered at Saudi dental schools. The responses obtained using the survey were subjected to statistical analysis using SPSS 20.0.

Results:

The results demonstrated that the dimensions, such as faculty characteristics, institutional characteristics, the efficacy of the program, and program changes due to the COVID-19 pandemic, were perceived as “High Quality.” The cumulative percentage of most of the items was graded as “Acceptable.” Overall, 89.2% of students were satisfied with the quality of the programs offered in their dental schools. A significant difference was found in students' perception of the dimensions and overall satisfaction with respect to their gender and dental schools.

Conclusion:

Overall, the students were highly satisfied with the quality of the dental program offered in Saudi Arabia. This study would help policymakers in developing appropriate strategies that can enhance and sustain the quality of dental program offered at Saudi dental schools.

Spatial distribution analysis of dentists, dental technicians, and dental therapists in Indonesia

Background: Access to health services is needed around the world, from healthcare providers to doctors. One of the needs in public health is a system that is accessible for everyone, but, unequal distribution of healthcare provider and health workers, especially in dentistry fields is still a main problem in several countries, including Indonesia. The aim of this study is to analyze the spatial distribution of dentists, dental technicians, and dental therapists. Methods: This spatial analysis study was conducted after obtaining secondary data in Indonesia. All data were collected between September 1 ^st, 2020 and October 1 ^st, 2020 from open access sources of de-identified data. The data of dentists per area, dental technicians per area, and dental therapists per area were calculated for analysis. A spatial distribution map was prepared using the Quantum Geographic Information System (QGIS Desktop, version 3.10.6). Results: The results of this study found a ratio of dentists to members of the population in Indonesia of 1:17,105. The average number of dental technicians that work in the public health centers in each province (dental technicians per area) in Indonesia was calculated to be 0.13. The average number of dental therapists that work in the public health centers in each province (dental therapists per area) in Indonesia was calculated to be 0.40. This spatial autocorrelation illustrates that there is a relationship between values of dentists per area and dental therapists per area between provinces in Indonesia, and shows geographic clustering relationships or patterns that are grouped and have similar characteristics in adjacent locations. This spatial autocorrelation did not occur in the value of dental technicians. Conclusions: From this study we can conclude that there is an unequal distribution of dental personnel in Indonesia.

Planning the Future Oral Health Workforce: A Rapid Review of Supply, Demand and Need Models, Data Sources and Skill Mix Considerations

Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A limited search was carried out on PubMed and Web of Science for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 countries were included in the review. A majority were from high-income countries (n = 17). Dentists were the sole oral health workforce group modelled in 13 studies; only five studies included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non-availability of the necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.

Needs-based planning for the oral health workforce - development and application of a simulation model

BACKGROUND

The World Health Organization's global strategy on human resources for health includes an objective to align investment in human resources for health with the current and future needs of the population. Although oral health is a key indicator of overall health and wellbeing, and oral diseases are the most common noncommunicable diseases affecting half the world's population, oral health workforce planning efforts have been limited to simplistic target dentist-population or constant services-population ratios which do not account for levels of and changes in population need. Against this backdrop, our aim was to develop and operationalise an oral health needs-based workforce planning simulation tool.

METHODS

Using a conceptual framework put forward in the literature, we aimed to build the model in Microsoft Excel and apply it in a hypothetical context to demonstrate its operability. The model incorporates a provider supply component and a provider requirement component, enabling a comparison of the current and future supply of and requirement for oral health workers. Publicly available data, including the Special Eurobarometer 330 Oral Health Survey, were used to populate the model. Assumptions were made where data were not publicly available and key assumptions were tested in scenario analyses.

RESULTS

We have systematically developed a needs-based workforce planning model for the oral health workforce and applied the model in a hypothetical context over a 30-year time span. In the 2017 baseline scenario, the model produced a full-time equivalent (FTE) provider requirement figure of 899 dentists compared with an FTE provider supply figure of 1985. In the scenario analyses, the FTE provider requirement figure ranged from 1123 to 1629 illustrating the extent of the impact of changing parameter values.

CONCLUSIONS

In response to policy makers' recognition of the pressing need to better plan human resources for health and the scarcity of work in this area for dentistry, we have demonstrated the feasibility of producing a workable, practical and useful needs-based workforce planning simulation tool for the oral health workforce. In doing so, we have highlighted the challenges faced in accessing timely and relevant data needed to populate such models and ensure the reliability of model outputs.

Using Item Response Theory to evaluate the psychometric characteristics of questions in a Brazilian programme and the performance of dental teams in primary care

Objectives

First, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items.

Methods

Secondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the ‘National Programme for Improving Access and Quality of Primary Care’. Twenty-three mandatory questions about the dentists’ reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument—level of difficulty and discrimination parameter of each item—and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4.

Results

Three of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance’s score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01.

Conclusion

The findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population.

Capacity building in health care professions within the Gulf cooperation council countries: paving the way forward

BACKGROUND

There is a worldwide shortage of health care workers. This problem is particularly severe in the Gulf Cooperation Council (GCC) countries because of shortages in certain medical disciplines, due to a lack of nationally-trained professionals and a less developed educational system compared to other high income countries. Consequently, GCC countries are heavily dependent on an expatriate health care workforce; a problem exacerbated by high turnover. We discuss challenges and potential strategies for improving and strengthening capacity building efforts in health care professions in the GCC.

MAIN TEXT

In the GCC, there are 139 schools providing professional health education in medicine, dentistry, pharmacy, nursing, midwifery, and other specialties. Health education school density reported for the GCC countries ranges between 2.2 and 2.8 schools per one million inhabitants, except in Oman where it is 4.0 per one million inhabitants. The GCC countries rely heavily on expatriate health professionals. The number of physicians and nurses in the GCC countries are 2.1 and 4.5 per 1000 respectively, compared to 2.8 and 7.9 among member countries of the Organisation for Economic Cooperation and Development (OECD). Interestingly, the number of dentists and pharmacists is higher in the GCC countries compared to OECD countries. A nationally trained health care workforce is essential for the GCC countries. Physiotherapy and occupational therapy are two identified areas where growth and development are recommended. Custom-tailored continuing medical education and continuing professional development (CPD) programs can augment the skills of health practitioners, and allow for the expansion of their scope of practice when warranted.

CONCLUSION

Capacity building can play an essential role in addressing the major health challenges and improving the overall quality of health care in the region. Efforts aimed at increasing the number of locally-trained graduates and developing and implementing need-based CPD programs are vital for capacity building and lifelong learning in health care professions.

Review and analysis of Chilean dental undergraduate education: curriculum composition and profiles of first year dental students

BACKGROUND

In Chile, dentistry has become a very popular career choice for students, which has resulted in a substantial increase in both, the number of dental graduates and dental schools. Nonetheless, there is a need for change in the way dental schools select and educate their students to keep pace with the rapidly changing nature of societal needs and to tackle the marked health inequalities that exist in the country. The aim of this study was to review and critique dental undergraduate education in Chile, with a particular focus on the curriculum composition and profiles of students admitted to dental schools from 2010 to 2014.

METHODS

A descriptive and retrospective design was utilised. Two different methods were undertaken: primary data collection regarding curriculum and secondary data analysis in relation to students' profiles. Descriptive statistics were used to assess the relative proportions of subject modules within the undergraduate dental curriculum and in particular the public health components. The analysis of the student profiles described specific background factors, namely, gender, age, secondary school type, location, rural-urban status and student's year of admission. Also, trends of dental students' intake between 2010 and 2014 were investigated. Logistic regression analysis was undertaken to assess potential associations between the aforementioned background factors and students' choice of dental school.

RESULTS

Regarding the curriculum review, a 67% response rate was obtained. The most dominant component of Chilean dental curriculum was the clinical subjects (33%), followed by the basic and biological sciences (16%) and then medical and dental sciences (13%). In relation to the admission of students, the majority attended private schools (72%); most were females (62%); aged 19 years or less (74%); had an urban origin (99%); and came from subsidised private secondary schools (48%). Significant differences were found between students admitted to traditional and private dental schools.

CONCLUSIONS

Clinical sciences are the most dominant subjects in the Chilean dental curriculum. Overall, traditional and private institutions had a broadly similar composition in their curriculum with the exception of the public health component. Students from disadvantaged backgrounds were the minority in dental schools across Chile.

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.

The characteristics and distribution of dentist workforce in Saudi Arabia: A descriptive cross-sectional study

BACKGROUND

The Kingdom of Saudi Arabia has shown steady growth in the dental workforce over the last 20 years. Although the number of dental colleges has significantly increased in the last decade, there is not any study so far that described the status of the licensed dentist workforce in the kingdom. The present study aimed to explore the demographic distribution and professional characteristics of licensed dentist workforce in Saudi Arabia.

METHODS

This was a descriptive cross-sectional study using the Saudi Commission for Health Specialties (SCFHS) database to identify the number of licensed dentists in Saudi Arabia as well as their professional and demographic characteristics as of December 2016. The data was categorized based on gender, nationality, dental specialty, health sector, geographic location, and professional rank.

RESULTS

The number of licensed dentists working in the kingdom as of December 2016 was 16887 dentists, and the vast majority of them are professionally registered as general dentists (70.27%). The percentage of general dentists among the professionally registered female dentists is significantly higher than their male counterparts (79.71% vs. 64.80%; P < 0.001). Only 22.08% of the dentists working in the kingdom are Saudi. Most of the dentist workforce in the kingdom are male (61.06%). The mean age of the Saudi dentists is slightly but significantly younger than non-Saudi dentists (37.7 vs. 40.7 years; P < 0.001). Over 80% of the Saudi dentists are working in the regions of Riyadh, Makkah, and Eastern province. About 66% of the Saudi dentists are working in the public health sector in comparison to only 20.46% of the non-Saudi dentists (P < 0.001).

CONCLUSIONS

Most of the dental care in Saudi Arabia is provided by non-Saudi dentists in both private and public health sectors. With the rising unemployment rate among Saudi dentists, the governmental bodies that are responsible of dental labor market regulations such as the ministries of health, economy and planning, and labor should come up with a policy to gradually but carefully replace the non-Saudi dentists in both public and private sectors with Saudi dentists.