Mutual recognition of qualifications, health workforce migration, and graduate outcomes: a comparative mapping study of undergraduate dental education in Europe.

BACKGROUND: The resource needs of health services are served by the recognition of qualifications across borders which allows professionals to migrate between countries. The movement of dentists across the European Union (EU), especially into the United Kingdom (UK), has provided a valuable boost to workforce supply. Recent changes to policy recognising overseas qualifications have brought attention to the equivalence of qualifications awarded in EU countries. Professional regulators need to be confident that dentists who qualified elsewhere have the appropriate knowledge, skills and experience to practise safely and effectively. The aim of this study was to compare UK and EU dental curricula, identify any differences, and compare the extent of pre-qualification clinical experience. METHODS: This was a mixed methods study comprising a questionnaire and website searches to identify information about curricula, competences, and quality assurance arrangements in each country. The questionnaire was sent to organisations responsible for regulating dental education or dental practice in EU member states. This was supplemented with information obtained from website searches of stakeholder organisations for each country including regulators, professional associations, ministries, and providers of dental education. A map of dental training across the EU was created. RESULTS: National learning outcomes for dental education were identified for seven countries. No national outcomes were identified 13 countries; therefore, learning outcomes were mapped at institution level only. No information about learning outcomes was available for six countries. In one country, there is no basic dental training. Clinical skills and communication were generally well represented. Management and leadership were less represented. Only eight countries referenced a need for graduates to be aware of their own limitations. In most countries, quality assurance of dental education is not undertaken by dental organisations, but by national quality assurance agencies for higher education. In many cases, it was not possible to ascertain the extent of graduates' direct clinical experience with patients. CONCLUSIONS: The findings demonstrate considerable variation in learning outcomes for dental education between countries and institutions in Europe. This presents a challenge to decision-makers responsible for national recognition and accreditation of diverse qualifications across Europe to maintain a safe, capable, international workforce; but one that this comparison of programmes helps to address.

Progress and challenges in the harmonisation of European undergraduate dental education: A systematic literature review with narrative synthesis.

INTRODUCTION: Harmonising education to support workforce mobility has been a policy objective for the European Union. However, alignment across varied national contexts presents challenges in dental education. METHODS: A systematic literature review with narrative synthesis. Searches of the electronic databases Embase [Ovid]; MEDLINE [Ovid]; Scopus; CINAHL; AMED and PsycINFO were conducted for relevant material published between 2000 and 2019 on undergraduate curricula, quality standards and learning outcomes in dentistry. RESULTS: Seventy-six papers met the inclusion criteria. Fifty-three papers were commentaries or editorials, twenty-one were research studies, and two were literature reviews on specific dental subfields. Eighteen of the research studies reported surveys. The literature contains extensive proposals for undergraduate curricula or learning outcomes, either broadly or for subfields of dentistry. Included papers demonstrated the importance of EU policy and educator-led initiatives as drivers for harmonisation. There is limited evidence on the extent to which proposed pan-European curricula or learning outcomes have been implemented. The nature and extent of dental students' clinical experience with patients is an area of variance across European Union member states. Arrangements for the quality assurance of dental education differ between countries. DISCUSSION: Harmonisation of European dental education has engaged educators, as seen in the publication of proposed curricula and learning outcomes. However, differences remain in key areas such as clinical experience with patients, which has serious implications if graduate dentists migrate to countries where different expectations exist. Mutual recognition of professional qualifications between countries relies on education which meets certain standards, but institutional autonomy makes drawing national comparisons problematic.

Mental health and wellbeing interventions in the dental sector: a systematic review.

Introduction UK dentists experience high levels of stress, anxiety and burnout. Poor mental health can lead practitioners to exit the profession, contributing to workforce and service loss. Therefore, there is a need to focus on interventions to protect the mental health and wellbeing of dental teams. Three levels of intervention can be deployed in the workplace to support mental health and wellbeing: primary prevention, secondary prevention, and tertiary prevention.Aim The aim of this systematic review was to identify evidence on interventions used to prevent, improve or tackle mental health issues among dental team members and dental profession students in countries of very high development.Methods This systematic review was conducted according to a predefined protocol and reported according to PRISMA guidelines. The MEDLINE, Embase CINAHL, DOSS, Scopus, and PsycINFO databases were searched. Prospective empirical studies were considered for inclusion. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) was used to assess the methodological quality of the included studies. The identified interventions were categorised according to level of prevention.Results The search yielded 12,919 results. Eight studies met the inclusion criteria. All of the studies concerned dentists or dental students. There were no studies for other groups of dental professionals. No primary prevention-level studies were identified. Secondary prevention-level studies (n = 4) included various psychoeducational interventions aiming to raise awareness and improve coping skills and led to significant improvements in stress levels and burnout of dentists and dental students. Tertiary prevention-level studies (n = 4) mainly employed counselling which was shown to be beneficial for dentists and students experiencing psychological ill-health.Conclusions Mental wellbeing awareness should be put at the centre of dental education and the workplace. Leadership and innovation are required to design primary-level interventions which can be implemented in the UK dental sector, with its distinct organisational and service characteristics.

Recruitment and retention in dentistry in the UK: a scoping review to explore the challenges across the UK, with a particular interest in rural and coastal areas.

Introduction There is currently reduced access to NHS dental services in the UK, particularly in England, with rural and coastal areas significantly affected. Recruitment and retention in dentistry has been highlighted as an issue contributing to the problem.Objectives To explore what is known or unknown about recruitment and retention of the dental workforce in the UK, with a particular focus on rural and coastal areas. We were keen to gain information relating to factors affecting recruitment and retention, geographical distribution of the workforce, anticipated challenges, strategies or proposals to assist workforce planning and the extent of empirical research.Methods Searches for peer-reviewed literature and reports were undertaken and included when they met the eligibility criteria. Data were extracted and the findings narratively synthesised.Discussion The findings suggested wide ranging recruitment and retention issues of the dental workforce in the UK. Most issues were associated with NHS dentists, followed by dental nurses across both the NHS and private sectors. The worst affected parts of the country were rural and coastal areas.Conclusion It appears from the evidence that there are many dental professionals discussing recruitment and retention issues, followed by stakeholders. However, there is limited research and data to initiate change.

Dental practice workforce challenges in rural England: survey into recruitment and retention in Devon and Cornwall.

Introduction Devon and Cornwall have been identified as 'dental deserts' with limited NHS dental access and high levels of oral health inequality. Challenges around recruitment and retention of the dental workforce have been acknowledged as an important contributory factor.Aims The aim of this research was to explore the experiences of dental practices within Devon and Cornwall in relation to recruitment and retention of the dental workforce.Method A self-administered, online questionnaire was used to explore various aspects of workforce recruitment and retention. The questionnaire included categorical rating scale and free-text question formats providing quantitative and qualitative data.Results In total, 106 dental practices responded to the survey, providing a response rate of 36%. The vast majority of respondents (94%) considered recruitment and retention to be a major barrier to delivering NHS services. Additionally, 77% of practices had a current staff vacancy, 57% had a dentist vacancy and 48% had a vacancy for dental nurses. Thematic analysis led to identification of four main themes which were considered to influence recruitment and retention: NHS system; economic challenges; logistics; and support networks.Conclusion A large number of dental practices in Devon and Cornwall are failing to operate at capacity due to workforce shortages, which is affecting access to services in both NHS and private practices. Recruitment and retention of dentists and dental nurses appears to be the most challenging factor, with NHS practices affected more than the private sector.

The dental workforce recruitment and retention crisis in the UK.

The precarious state of NHS dentistry is widely acknowledged, yet there is limited progress in addressing the underlying issues. Further delays will undoubtedly impact patient care, leading to oral health deterioration and unnecessary suffering. This will predominantly affect the most vulnerable in society, resulting in greater oral health inequalities.The underlying issues contributing to the current NHS dental crisis are many, and they include: prolonged delays in contract reform; long-term underinvestment; private sector growth; and fewer dentists working full-time and/or in the NHS. In England, an NHS dental contract that fails to promote prevention or equality of access continues to have a deep and pernicious impact on the future of NHS dentistry. The devastating impact of the COVID-19 pandemic on access cannot be underestimated and neither should the effect of Brexit on the availability of workforce.The recruitment and retention of dentists, and other members of the dental team, is undoubtedly a major issue in terms of capacity and access to NHS dental care. These problems, seen across the UK, are a particular issue in England, with acute challenges within rural and coastal areas.There is an urgent necessity to develop coherent, multifaceted strategies, aided by the collection of clear and accurate workforce data, to tackle these issues.