The dental workforce in Malaysia: career motivation and expectations amongst senior dental students

The dental workforce globally is facing unprecedented change as a result of multiple influences. Malaysia, a high-middle-income country, has expanded the number of dental schools in the last decade to ensure that there are a sufficient number of health workers to meet the needs and demands of the population. As the volume of dentists entering the workforce has increased, concerns about the long-term implications of these policies and how this expensively trained dental workforce will be utilised in the future are emerging. There is a need for research informed action in relation to understanding workforce influences, and examining their potential implications and the shape of the future workforce in relation to population need. An understanding of the motivation of current dental students for choosing to study dentistry and their subsequent career expectations may assist with harnessing and retaining their skills. This is the first book in a series of three planned to be published concerning the dental workforce in Malaysia. The aim of this series is to present findings on motivation and short- and long-term career expectations of dental students in the selection of dentistry as a professional career in relation to individual (demographic and socio-economic factors) and school characteristics and make recommendations for the future in relation to serving the population. Senior dental students from 11 schools were invited in early 2013 to complete a questionnaire survey of the Gallagher Motivation Instrument (GMI) to examine career motivation and expectations. Univariate and multivariate analyses of the responses, including confirmatory factor analysis of career motivation, were undertaken followed by descriptive analysis of their career expectations. Three hundred and fifty six final year dental students (83%) across eight schools (73%) responded, comprising 66% of final years in Malaysia in 2013. Five motivational factors were reported with ‘academic’ factors emerging as students’ main motivation to study dentistry. There were some differences in motivation by school sector; either public or private and ethnicity. There was however no variation by sex, family income, age or the school type (established or new). Career expectations focused on specialisation in the short-term (46%) and long-term (59%) for students, with a desire to achieve financial stability and work/life balance. The majority of all respondents (64%) reported a desire to work in the private sector. Only 66.9% of respondents considered working full-time in the long-term with significant difference by sex [male (77.7%) and female (62.5%); (p=0.036)]

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

Current short-term career aspirations of dental students in Malaysia: post new employment policy = Malezya’daki diş hekimliği oğrencilerinin kısa dönem kariyer hedefleri: yeni İstihdam politikası sonrası

OBJECTIVE: It is important to revisit career aspirations of emerging dental graduates following the dynamic changes in employment policies in Malaysia for workforce stability. The aims of this study were to explore current students’ short career aspirations and their perceived influences, and whether their aspirations vary according to students’ characteristics. METHODS: All final year dental students who registered in 2017/2018 academic year (n=64) in International Islamic University of Malaysia (IIUM) were invited to participate in a self-administered questionnaire. The instrument explored the students’ motivation, short and long-term career aspirations and influences using mixture of open and close ended questions. Data were analysed using SPSS programme, including Chi-Squared test for linear association. RESULTS: The response rate was very high (n=62; 97%). The majority were aged 25 years (63%), female (71%), and come from high-income families (38%). All of the participants were Malaysian. In regard to their short-term aspiration, the participants mostly chose ‘gain knowledge/skill/experience’ (39%); followed by ‘undertaking specialist training’ (27%) and ‘getting a permanent job’ (20%). ‘Achieving financial stability’ (80.6%), ‘gaining professional experience’ (80.6%), and ‘balance of work-life’ (73%) were their greatest influences. Notably, there were significant differences between ‘having a break from study’ (p=0.030) and choosing area of practice (p=0.017) by family income. Furthermore, male students were anticipated to work in private sector more than their female counterpart (p=0.030). CONCLUSION: There is a transient with the most significant short-term career aspirations post new employment policy among Malaysian dental students to study dentistry. Enhancement of knowledge, skills and experiences was observed the greatest amongst all respondent; in securing financial and professional stability; as well as work-life balance. The students’ short-term career aspirations varied based on the students’ family income and gender

Career satisfaction of Malaysian dentists with expanded roles at a specialist clinic

Objectives:Public dentists interested in postgraduate studies were required to complete clinical attachments at the Malaysian Ministry of Health (MOH) Dental Specialist Clinic (DSC). This cross-sectional quantitative study aimed to explore career satisfaction (CS) and barriers perceived by Malaysian dentists at Malaysia's MOH DSC. Methods: A total of 208 dentists from DSC nationwide completed an online questionnaire in June 2022. Demographic data and information on dentists’ expanded roles were retrieved. Responses on dentists’ satisfaction and perceived barriers were collected using a 5-point ordinal scale. Mann–Whitney U and Kruskal–Wallis tests were used to compare the mean rank differences for CS. Factors influencing CS were analysed using multiple logistic regression (MLR) (P < .05). Results: The mean age of the respondents was 32.68 ± 2.48 years. Almost half (49.0%) of the respondents were attached to a non–hospital-based clinic. The majority (72.0%) of them were permanently attached to the DSC. About half of the dentists (51.0%) strongly agreed that they received no financial incentives for their expanded role at the MOH DSC. Dentists attached at a non–hospital-based clinic (P = .046), working with more than 15 years of experience (P = .013), and having 12 to 18 months’ duration of attachment (P = .014) were more satisfied. MLR analysis revealed that non-Malay respondents (odds ratio [OR], 1.54; P = .035) and those who applied for scholarships more than 3 times (OR, 1.85; P = .050) were more satisfied. In contrast, more than 19 months at the DSC decreased CS (OR, 0.44; P = .029). Conclusions: Despite having a similar organisational structure, DSC dentists had different satisfaction levels. Dentists’ ethnicity, duration of attachment, and frequency of applying for scholarships influenced their CS. Future career advancement plans in the MOH should consider these important influencing factors to ensure the delivery of quality health care from their personnel

Career satisfaction and barriers perceived among Malaysian dentists with expanded roles at specialist clinic

Public dentists interested in postgraduate studies were required to complete clinical attachments at the Ministry of Health (MOH) Dental Specialist Clinic (DSC). This cross-sectional quantitative study aimed to explore career satisfaction and barriers perceived by Malaysian dentists at MOH Malaysia's DSC. A total of 208 dentists from DSC nationwide completed an online questionnaire in June 2022. Demographic data and information on dentists' expanded roles were retrieved. Responses on dentists' satisfaction and barrier perceived were collected using a 5-point ordinal scale. The Mann-Whitney U and Kruskal Wallis Test were used to compare the mean rank differences for career satisfaction. Factors influencing career satisfaction were analysed using Multiple Logistic Regression (MLR) (p<0.05). The mean age of the respondents was 32.68 ± 2.48. Almost half (49%) of the respondents were attached to a non-hospital-based clinic. The majority (72%) of them were permanently attached to the DSC. Most dentists (50.96%) strongly agree they received no financial incentives for their expanded role at the MOH DSC. Dentists attached at a non-hospital-based clinic (p=0.046), working with more than 15 years of experience (p=0.013) and having 12 to 18 months duration of attachment (p=0.014), were more satisfied. MLR analysis revealed that non-Malay (OR=1.54; p=0.035) and those who applied for scholarships more than three times (OR=1.85; p=0.050) were more satisfied. In contrast, over 19 months at DSC decreased career satisfaction (OR=0.44; p=0.029). Despite a similar organisational structure, DSC dentists had different satisfaction levels. Dentists' ethnicity, duration of attachment, and frequency of applying for scholarships influenced their career satisfaction. Future career advancement plans in the MOH should consider these important influencing factors to ensure the delivery of quality healthcare from their personnel

Career expectations and satisfaction among Malaysian dentists with expanded roles at government dental specialist clinic

Introduction: Public dentists in Malaysia undergoing attachment at the Ministry of Health (MOH) Dental Specialist Clinic (DSC) hold enhanced skills that enable them to treat cases of intermediate complexity. Public dentists interested in pursuing post-graduate studies for career advancement were required to complete a period of clinical attachment at selected MOH DSCs. Objectives: This cross-sectional study aimed to explore dentists' expanded roles, career expectations and satisfactions at the MOH DSC. Methods: A total of 208 dentists from DSC nationwide completed an online questionnaire in June 2022. Demographic data and information on dentists' expanded roles were retrieved. Responses on dentists' career expectations and satisfaction were collected using a 5-point ordinal scale. Associations between sociodemographic and other variables were determined using the chi-square, independent t-test and ANOVA (p<0.05). Results: The mean age of the respondents was 32.68 ± 2.48. Almost half (49%) of the respondents were attached to a non-hospital-based clinic. 71% of the dentist was permanently attached at the DSC, while 21% were attached temporarily at the DSC. Permanently-attached dentists had significantly higher career expectations mean scores of 24.5 ± 5 compared to partially-attached dentists (27.2 ± 7) (p = 0.004). Dentists attached at a non-hospital-based clinic (p=0.046), working with more than 15 years of experience (p=0.013) and 12-18 months of attachment (p=0.014), had higher career satisfaction. Multiple logistics regression analysis revealed that non-Malay (OR=1.54; p=0.035) and those who applied for scholarships more than three times (OR=1.85; p=0.050) had a higher satisfaction level. In contrast, the duration of attachment at DSC of more than 19 months contributed to a lower career satisfaction level (OR=0.44; p=0.029). Conclusions: Dentists at DSC, MOH demonstrated diverse career expectations and satisfaction levels despite working under a similar organizational structure. Dentists' ethnicity, duration of attachment, workplace and frequency of applying for scholarships influenced their career expectations and satisfaction

Antimicrobial effect of seaweeds against oral-borne pathogens: a review

Dental caries is known as the most common and preventable dental disease. This multifactorial disease has been found to be a major concern worldwide. This dental caries has been proved to be caused by the presence of oral pathogen. Seaweeds show many health-promoting effects, including antimicrobial, anti-inflammatory, anti-oxidative and anti-cancer properties. The versatility of the seaweed has attracted many researchers to use seaweed extracts as alternative treatment against multiple diseases. However, little attention has been paid to the application of antimicrobial properties of seaweed against oral pathogenic microorganisms. The substances isolated from red, brown and green seaweeds showing potent antimicrobial activity are polysaccharides, phlorotannins, pigments, fatty acids, lectins, terpenoids, alkaloids and halogenated compounds. Current research is shifting into fully grasping the antimicrobial potential of seaweeds against oral microbes that cause dental caries or periodontal disease. Hence, this mini-review will highlight the antimicrobial properties of three types of seaweed species (red, brown, and green) against selected oral pathogenic microorganisms

A study on parental acceptance towards the use of dental therapists in Malaysian private sectors

Introduction: The objective of this study was to assess parental acceptance and factors that influenced their perceptions towards the use of dental therapists in providing treatment to children in private dental practice settings. Methods: A cross-sectional study was conducted on randomly selected parents of 11-year-old schoolchildren in Selangor using a self-administered structured questionnaire. The survey consisted of three sections: socio-demographic characteristics, dental service utilisation and parental acceptance towards dental therapists in providing seven types of preventive and operative dental procedures. Results: The response rate was 83.1%. Overall, most parents regarded dental therapists providing dental care to their children in private dental care settings as acceptable, particularly on preventive treatment, namely ‘seeking advice on oral hygiene care' (87.8%) and ‘applying topical fluoride' (83.2%). In the multivariate analysis, younger parents and those who had preferences over private sectors were most likely to accept at least four dental procedures to be rendered to their children by dental therapists. Overall, respondents who were younger (OR = 1.40, 95% CI = 1.62, 1.92), lived in urban locality (OR = 1.77, 95% CI = 1.28, 2.45) and had a recent dental visit (OR = 1.51; 95% CI = 1.10, 2.07) were more likely to have an overall positive perceptions towards dental therapists. Conclusion: Most parents regarded dental therapists providing care to their children in private dental settings as acceptable and this was associated with their age, place of residence and past dental experiences

Scenario modeling for dentistry in Malaysia: Utilization, privatization, and specialization

Aim: To study to model future clinical dental workforce scenarios in Malaysia, in relation to population need–demand, to inform future change. Materials and Methods: A system dynamics (SD) model was developed in Vensim-software to model the need/demand and supply for dental care across public–private sectors over 3 decades (2010–2040). This model included two sub-models relating to “need/demand” and “supply,” drawing on national evidence from two previous studies (student career surveys and interviews of key stakeholders nationally), together with relevant available data. This SD model provided the baseline model (S1) for Malaysia and four-distinctive-scenarios (S2–5), involving enhancing generalists–specialists across public–private sectors. An additional scenario (S6) was run to optimize workforce utilization, informed by career expectations of emerging graduates drawing on earlier scenarios (S2–5). Results: Modeling future five-scenarios highlighted the gap in dental workforce nationally across both sectors could range from a surplus of a total of 3739 dentists and 817 therapists in the baseline scenario to a total shortfall of 1249 dentists and surplus of 817 therapists by the year 2040, influenced by dentist working patterns, specialization, and privatization. Increasing the potential for specialist training and permitting emerging graduates’ to working part-time, while optimizing public sector primary care, and responding to the career expectations of emerging graduates, has the potential to absorb potential oversupply, and, thus, utilize the entire clinician dental workforce in Malaysia in the medium term. Conclusion: The findings of this model demonstrate the short-term requirement to expand the Malaysian dental workforce to meet dental needs of the population, highlighting that continued production at the current rate will result in oversupply, unless action is taken to maximize primary care, enhance specialization, and embrace flexible working to meet career expectations of graduates

Modelling the future Malaysian clinician dental workforce using system dynamics

Introduction: The aim of this operational research workforce project was to build, and test, a clinical dental workforce model for Malaysia to address population need/demand with a view to informing health policy. Methods: A system dynamics (SD) model was developed to take account of population oral health needs and demands and dental workforce supply nationally from 2010 to 2040. This involved building two sub-models: population need/demand; and dental workforce supply, drawing on evidence from two previous studies (student survey and interviews of key-stakeholders) supported by government data. The two sub-models were integrated in relation to clinical time to explore potential of over- or under-supply of clinical hours; were latter converted to clinical workforce numbers. The SD model was tested and validated as an acceptable baseline model for Malaysia using existing workforce data. Results: A SD model was developed to model the need, supply and demand for dental care in two sectors from 2010 to 2040. There is a short-term need for an expanded dental workforce to meet the needs of the population but there is a potential oversupply of dentists and therapists from 2040, or earlier. The level of public demand for both primary and secondary dental care is expected to increase respectively from the year 2010 to 2040, varying in relation to demographic and health trends across public and private sectors. Conclusion: The study suggests there is are current requirements for an expanded dental workforce to serve the population needs/demand and potential for oversupply from 2040, or earlier