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Introduction: The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods: The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results: A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions: The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.
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INTRODUCTION: Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India. METHODOLOGY: The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review. RESULTS: In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India. CONCLUSIONS: This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.
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Delivery of Health Care , Oral Health , Humans , Health Policy , India , WorkforceABSTRACT
The aim of this study was to identify clinico pathological indications for radical resection of odontogenic keratocysts (OKCs) in the literature and formulate clinical guidelines for the management of OKCs based on these findings. A systematic review of the literature was undertaken in September 2021 in PubMed/Medline, Scopus, Web of Science, Google Scholar, and Cochrane databases. The following MeSH Keywords terms were used in the search strategies: (odontogenic keratocyst) OR (keratocystic odontogenic tumor) OR (primordial cyst) AND (treatment) OR (Radical resection) OR (Resection of OKC) OR (Treatment methods). Eligibility criteria included publications of clinical studies on histologically confirmed OKCs which underwent radical resection. Studies with less than 5 OKCs, experimental studies, epidemiological studies, studies that included orthokeratinized odontogenic cyst, and review papers were excluded. Ten studies on OKCs reporting on segmental or marginal resections were identified and analyzed qualitatively. Of the total of 221 OKCs that underwent radical resection, 67 OKCs were primary, 30 were recurrent, and the remaining were unclear whether they were primary or recurrent. Segmental mandibulectomy was performed in 131 OKCs, marginal mandibulectomy in 87 OKCs, and 3 OKCs were treated by partial maxillectomy. The main indications for radical resection were multilocular appearance, large OKCs (> 5 cm), multiple recurrent OKCs with or without cortical perforation, and malignant transformation. In conclusion, radical resection has its place in the management of OKC. It is indicated when there is an aggressive lesion with bony perforation, involvement of the pterygoid musculature or skull base, and malignant transformation. The surgeon should aim to identify these features to manage OKC appropriately and to prevent multiple recurrences. Clinical guidelines for the management of OKCs are proposed.
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INTRODUCTION: Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority. AIM: The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally. METHODS: Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes. RESULTS: Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care. CONCLUSION: The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic.
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COVID-19 , Pandemics , Accreditation , Dentists , Humans , SARS-CoV-2 , State Medicine , United KingdomABSTRACT
Medical education and training of health professionals are linked with their recruitment and retention. Practising as a competent health professional requires life-long continuous training and therefore training structures in health systems appear to influence doctors job satisfaction, their well-being and their intentions to remain in that health system. The commentary critiques aspects of the paper on doctors retention in Ireland, while drawing some parallels with the United Kingdom. There appears to be an emerging type of health professional migrants 'education tourists' who travel to other countries to obtain medical education creating new routes of migration and this presents new challenges to source and destination countries. The global shortage of doctors and other health professionals further exacerbates health inequalities as seen in the present pandemic and therefore the increased need for research into health professionals' migration and their integration.
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Emigration and Immigration , Physicians , Cross-Sectional Studies , Humans , Ireland , Professional Practice LocationABSTRACT
INTRODUCTION: The National Health Service's reliance on overseas doctors and nurses, unlike dentists, has been widely reported. As the United Kingdom (UK) leaves the European Union, an understanding of the migration trends and possible influences are important to inform future planning. AIM: To examine trends in the profile of UK registered dentists in the context of key events and policy changes from 2000 to 2020. METHOD: Data were obtained from the General Dental Council via annual reports, and under 'freedom of information' communications; details of policy initiatives were obtained from the government and professional websites. RESULTS: Over a 20-year period (2000-2019), the number of registered dentists increased from 31,325 to 42,469, a net increase of 36% (11,144 dentists), the majority of whom were international graduates (58%; n = 6,416) such that by December 2019, 28% of all registered dentists had qualified outside of the UK. Similarly, regarding new registrants, there were increases of graduates from UK (18%), EEA countries (214%) and, via the Overseas Registration Examination route (621%); and a decrease from countries with bilateral agreements for recognition (43%), in line with changes in health and immigration policies. CONCLUSIONS: International dental graduates increasingly contribute to the UK dental workforce and there is an urgent need for research into dentist migration and retention in the UK in support of patient access to dental care. IMPACT: The United Kingdom (UK) dental workforce is increasingly reliant on international dental graduates representing 28% of current registrants compared with 18% in 2000. Health policies and immigration policies were the main drivers that influenced dental workforce migration to the UK along with wider events, such as EU expansions, global recession and Brexit. Pre-existing lack of research into dental workforce could add to the uncertainties of post COVID-19 oral health care access and delivery.
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Background Many dental professionals are now completing higher degrees that involve a research project. However, many of those research projects, although worthwhile, are not written up for publication in a peer-reviewed journal.Aim To encourage and assist novice authors in transferring their project report into a paper to submit for publication.Discussion The relationship between the authors and contributors is considered, and advice is given on how to focus on the specific research question and produce a succinct paper within the target journal's word limit. Emphasis is placed on choosing the right journal for submission and the need to follow the 'instructions to authors', as well as what happens post-submission, post-acceptance and post-publication. Furthermore, some of the difficulties that the authors have encountered on their own publication journeys are highlighted.Conclusion Great satisfaction will be derived if the novice researcher makes the most of their opportunity of undertaking a research project and subsequently getting it published in a peer-reviewed journal. Publishing gives the author recognition within their professional community, a feeling of personal achievement, can create better career perspectives and allows others to build on the work.
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Publishing , Writing , Peer ReviewABSTRACT
BACKGROUND: The purpose of the present study was to resolve whether caregiving for a child with disability influences the physical and mental health of the caregivers and whether stress is related to the quality of life of the caregivers. METHODS: The Parental Stress Scale questionnaire for the assessment of parental stress and the Short Form-12 version 2 questionnaire for the assessment of physical and mental health quality of life were distributed among 69 parents of developmentally disabled children and 137 parents of healthy children (control group). Various sociodemographic factors were also included. RESULTS: A significant difference was seen between the two groups in terms of employment, presence of disabled sibling, smoking, and physical activity. Parents of developmentally disabled children had significantly higher stress levels and worse mental health-related quality of life. Overall physical health quality of life was similar between cases and controls. Stress had a negative correlation with both mental and physical health quality of life of the parents. CONCLUSION: Stress related to raising a child with disability negatively influences the parental quality of life. Stress management aiming at its prevention and reduction might be significant aspects of intervention for the improvement of the quality of life of the caregivers.
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Disabled Children , Caregivers , Case-Control Studies , Child , Humans , Parents , Quality of Life , Stress, Psychological , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The aim of this review was to examine the migration motives, the barriers to and facilitators of integration of international dental graduates, compared with nurses and doctors in the United Kingdom. METHODS: Electronic databases Ovid MEDLINE, EMBASE, PubMed, Web of Knowledge and OECD publications were systematically searched for English language publications from January 2000 to January 2017. A total of 31 qualitative studies were selected and quality appraised and meta-synthesis of the qualitative data was carried out using framework synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings. RESULTS: There were no studies on migration motives and one study on integration experiences of international dentists in the UK. The nursing literature had the highest volume and quality of evidence on nursing workforce, whilst there was limited literature on international doctors in the UK. Migration of health professionals to the UK is determined by personal and professional factors, together with source country-specific and UK drivers. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuate migration into the UK, but the extent to which each of these drivers influence nurses' and doctors' migration is different. Integration experiences for international nurses and doctors differed based on their source country experiences and the work environment they entered. Nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared to the doctors. The migrants' integration experiences depend on their cultural awareness, discrimination exposure, English language and communication skills, social and professional support networks, social integration and personal attributes. CONCLUSION: Migration of international health professionals is motivated by macro, meso and micro drivers at the international, national, professional and personal levels. The UK has strong common macro pull factors which attract nurses, doctors and dentists and may impact on the effectiveness of policies to restrict their migration. The integration experiences of nurses and doctors differ and further research is required to understand the integration experiences of dentists, in order to retain these professionals by tailoring policies to each of these professions.
