Bridging the Gap: Exploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study

Bridging the Gap: Exploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Bridging the Gap: Exploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study Hoda Wassif, Archana Naik This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8329541/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Aim Overseas qualified dentists (OQDs) make up a significant portion of the UK dental workforce, yet there is limited research on their experiences, particularly regarding their mentorship needs. This study explores OQDs’ perceptions of mentorship, its value, and effectiveness, with the aim of informing evidence-based recommendations to better support this group. Methods A qualitative research approach was adopted, involving ten in-depth semi-structured interviews with OQDs who had registered in the UK within the last fifteen years. The interviews, totalling approximately eight recorded hours, were analyzed using thematic analysis with an inductive approach. Results Four key themes emerged from the data. The first theme, OQD and the Mentor, captured participants’ overall mentorship experiences, highlighting, the benefits and their unmet needs. The remaining three themes addressed specific challenges faced by OQDs: OQD and the Patient, which explored logistical, cultural, communication, and litigation-related difficulties; OQD and the Dental Team, which examined team dynamics and professional integration; and OQD and the System, which identified systemic barriers within the UK dental sector. Discussion While OQDs recognized mentorship as highly valuable, their experiences varied widely, with many reporting significant challenges. Given the substantial role OQDs play in the UK workforce, their mentorship experiences not only affect individual career progression but also impact team cohesion, workforce retention, and patient care. Understanding these challenges is essential for developing targeted mentorship strategies that support the growth and development of the workforce. Health sciences/Health care/Dentistry/Dental education/Dental post graduate education Background Mentoring has various definitions in healthcare, but a widely accepted one is ‘helping another person become what they aspire to be’ 1, 2 . Coaching is often used interchangeably with mentoring, and while they differ, both support personal and professional development 3, 4 . This study draws on literature related to both. The benefits of mentoring across dentistry and all aspects of healthcare have been well-documented 5, 6 with a particular focus on its value towards preventing burnout & attrition 3, 7 , enhancing performance 8 , supporting health, well-being, career progression 9 , and being a useful tool for workforce planning and retention 10, 3, 11, 12 . Mentoring has also been linked to reducing the sense of isolation among general medical practitioners (GPs) 13, 14 . Unlike multidisciplinary teams in hospitals, the institutional set-ups of dental practices in the UK have been likened to GP practices; Isolation has frequently been associated with daily dental practice 15, 12 . Holt and Ladwa 2 , therefore, have advocated for mentoring pilot schemes for general dental practitioners (GDPs) based on the comparable experiences of GPs. Overseas Qualified Dentists (OQDs) encompass a significant and increasing proportion of the workforce in dentistry, 46% of new dentists on the 2022 General Dental Council (GDC) register were OQD’s 16 . The GDC has tripled the number of Overseas Registration Exam (ORE) places and is consulting on modernising examination routes for OQDs to increase numbers and remedy the COVID-19 backlog 17, 18, 19 . The GDC has not officially defined OQD’S whilst the British Dental Association (BDA) considers any dentist qualified outside the UK an OQD, regardless of their country of qualification 20 . As dentists emigrating from the European Economic Area (EEA) can currently register with the GDC without going through the ORE exam which is mandatory for dentists from the rest of the world; they are sometimes not considered OQDs 21, 22 . Nevertheless, given the language, culture and training differences compared to their home countries, it seems reasonable to concur with the literature 23 that EEA-qualified graduates face similar challenges to other OQDs and excluding them from the overseas category could ignore their support needs and skew critical evidence. Therefore, for this research, all dentists with a primary qualification outside the UK will be considered OQDs 24 . Although research on OQDs in relation to mentoring is limited in the UK, OQDs in the USA and Australia have reported challenges such as structural barriers, discrimination, isolation and loss of identity 25, 26 . The need for support and value of mentoring in overcoming similar challenges is evidenced in research on International Medical Graduates (IMGs) and International Qualified Nurses (IRNs) 27, 28, 29, 30 . Research 31 identified that a lack of workplace support in facing acculturation hurdles could contribute to the overrepresentation of IRNs in FTP processes 32, 33, 34, 35, 36, 37 . Given that OQDs face relatively similar challenges and considering the recent Government consultation on provisional registration as an additional and alternative route for international dentists to work under supervision in the UK, understanding what effective mentorship means to OQD’s seems crucial towards supporting this group, their supervisors and their patients 38 . Data on OQD mentoring experiences is sparse and has been reported as informal and variable, with OQDs receiving mentorship through their communities or social media groups 39 . The differing needs for support and integration of migrant professionals have been well documented 25, 26, 28, 30 , however, similar data remains scant in dentistry, and the need to fill this gap in the literature is the rationale for this study. This study aims to explore what OQD s perceive as effective mentoring, and why, by examining their lived experiences. It also aims to explore areas in which OQDs perceive their needs for mentorship and their strategies in how to seek that support. Methods This study focused on exploring participants' perceptions of mentorship experiences, therefore a qualitative approach was adopted to explore participants lived experiences 40, 41 with semi-structured interviews chosen as the data collection tool 42 . Ethical approval was obtained from the University of Bedfordshire (Ref: 02/DLE/03/2024-2009679). Participants were recruited using purposive sampling focusing on OQDs who graduated during or after 2009 43 . Due to their experiential learning and integration through time, OQDs qualified over 15 years were excluded from the study. Participant information and consent forms were obtained from each participant and no incentives were offered for participation. Each participant (P) was designated a number P (1–10) in order to maintain anonymity. Data collected provided a manageable yet rich source of qualitative data. Interviews ranged between 30 to 60 minutes with an average of 48 minutes. One-to-one, online, pilot interview took place for calibration and to refine interview techniques (not included in the final results), and questions and strategies were revised using structured feedback and reflection 44, 42 . Interviews were conducted, recorded and coded by the first author using Microsoft Teams. Transcribing the interviews formed the initial stages of the thematic analysis as it allowed the authors to immerse themselves in the raw data and to effectively observe the developed themes. Manual coding took place, with themes and subthemes later identified. Regular checks and reviews of interview techniques and practices were implemented throughout the study. During the interviews, participants were presented with a collage of postcards portraying various experiences and emotions to augment data enrichment and to aid reflection about the topic 45 . Results Ten semi-structured interviews were completed with 9 female and one male participants. Qualitative data was deconstructed with patterns and themes identified using Braun and Clarke’s six-phase framework thematic analysis using an interpretative paradigm 46 . Four themes were identified as follows: OQD and the mentor, OQD and the patient, OQD and the dental team and OQD and the wider system. Further subthemes were included within each individual theme and presented below. OQD and the mentor The experiences of OQDs were variable, and subthemes were identified as part of participants' engagement with their mentors Overall Mentorship Experience Numerous participants expressed that their mentors lacked experience, understanding and training in mentoring OQDs. They felt it was critical to note that OQDs are a unique group with distinct needs, and the needs of each OQD differ within that group. “ I was thrown in the deep end, it was quite hard and a bit challenging… t he mentor had no idea how much I knew or what I was expecting. My mentor expected that I knew everything and [that] I'm just gonna start” P1 “ I'm coming with one year experience or someone else is coming with ten years of experience. The mentoring needs of both clinicians will be very different” P2 Multiple participants described that mentors who were either OQDs themselves or those with experience of supporting OQDs were more likely to be effective mentors for this group. “ I think my mentor, because he was very experienced, [having] dealt with a lot of dentists from Iran, he kind of had the hack of how different dentists from different countries operate” P10 “ An overseas dentist is obviously going to understand and could be a good mentor but also someone who have experience of seeing what [OQDs] struggle with can also be an effective mentor” P3 Professional and Personal Impact Participants described how their mentors impacted them professionally as well as personally, through the mentorship and beyond. “I joined the University thinking that I will do the PhD, but then [my mentor negatively] impacted my psychological and personal life that much that I had to stop at MPhil...I used to cry at the bus stops” P9 Multiple participants felt that mentors held a certain amount of soft power over them in the relationship. “ If you don't like a mentor you still stick to it no matter what I think the fear is definitely there as well as a culture of respect and submissiveness to our seniors. [Mentors] have the power to use abuse or misuse that individual” P10 Value of mentorship Despite their variable experiences, all participants felt that mentorship was valuable when starting work in the UK. Many highlighted that a mentor was also crucial for managing stress when things went wrong and career guidance was needed. “It is not just clinical issues it should be...how you will personally deal with your stress” P5 “ You need mentorship all the way through your life, even if you get the best mentorship even in the beginning of the years, you still face some challenges, having a mentor will definitely help in those situations” P3 OQD and the Patient All participants perceived patient care in the UK to be overwhelmingly different from their home countries. Many participants found treatment protocols, NHS payments based on Units of Dental Activity (UDA) and professional guidelines difficult to grasp. This theme focused on interactions with patients and their care, as well as how OQDs navigated the needs of their patients within a different system. Delivering effective patient care in the UK dental system “ What [OQDs] do need some advice is how to open plans, close plans on the NHS system, UDA contracts which are not done anywhere else in the world” P6 “ We would just write [back home] not as much details as it is here, record keeping was the area that I was struggling [with]” P9 Various participants expressed that not being able to perform basic procedural tasks made them feel inadequate and that mentorship could be valuable towards combatting this. “Suddenly in the system you are feeling why are you struggling with things, which people say it's basis, so makes you feel a little incompetent which you are not“ P10 Communication and Culture Communication was a dominant sub-theme, and nearly all participants commented on communication hurdles in varying forms. Most expressed that communication difficulties were not merely about English language fluency but cultural differences and colloquial slang. Cultural norms mattered; many words had different interpretations in their own country of origin, so understanding what the patient meant was difficult. While some were able to navigate these challenges mostly by observing their mentors over time, others felt let down by mentors in this regard. “Different parts of the UK, their slangs are different, so I did initially struggle” P3 “For example, back home, “you all right?” means you suspect something is wrong, and that's why you're saying you all right?, but here it is seen like “how are you?” P10 “ Starting from how to greet patients, [they] mean things in a different way [which], was difficult for me to understand.” P9 Furthermore, many participants said they were used to a different patient mindset; the concept of continuing preventative care, the critical need to build rapport with patients, involve them in their care, communicate consent, and its significance in the UK all seemed alien to them. “ Patients [back home] come only when there is a problem, it's not preventive care. Over here, the culture of NHS is a different way of developing a rapport, so it does take a while to understand” P2 Participants frequently reported that communication barriers caused feelings of anxiety and fear which impacted their confidence, and therefore a mentor could be pivotal. Dealing with Patients Complaints Patient complaints and litigation were consistent stressors among participants; many expressed that complaints were not usually taken seriously in their home countries. Many reported feelings of panic and stress that substantially impacted their well-being, explaining the critical need for mentorship during these times, not merely as a reactive tool but also a preventative measure. “Most overseas dentists have never handled a complaint before, and they might take a complaint lightly but in UK complaints are taken very seriously so I think, in the initial years, [OQD’s] do need some direction” P6 “We never studied or worked in a system where we had to worry so much about defending ourselves all the time” P10 OQD and the Dental Team Several participants felt that a positive mentorship experience improved their teamwork skills, and some explained that mentors enhanced team cohesion. “ Initially, I used to be very limited in terms of the communication with my work team, but with the ongoing time in the mentorship...I'm more in touch with my whole team” P7 “... we have created the culture where we support each other. [Mentorship] has changed the entire way of working in the clinic” P2 However, multiple participants reported challenges like feeling misunderstood and struggling with cultural norms, which made them feel isolated even if they had clinical support from their mentors. Non-clinical mentorship support was considered valuable for overcoming some of these integration barriers within teams. “ Even though you have [clinical] mentors, nobody understood my culture there, I think having a mentor to just explain these kind of things to you [like] saying please, thank you, would have helped me embed into this system a lot more easily” P3 OQD and the System Mentorship Channels Challenges in securing NHS mentorship positions were another recurring theme among participants. These included offers of low remuneration and exploitative mentorship contract terms, with some confirming that they had to pay mentors to acquire these positions. “ Once I finished my ORE, finding the place for [NHS mentorship], that was a nightmare” P8 “I know quite a few who have struggled with getting a mentor. They either had to move cities or compromise to a lower income or another two year or five-year commitment or waiting three years before they can be mentored” P2 “ I had to pay the mentor an agreed sum every month for 12 months, although my mentoring was only for nine months” P1 Unable to secure NHS mentorship positions, some participants resorted to work in the private sector. “ There is no dearth of mentoring in the private sector” P2 “ There is a sense of pride to work with the NHS and [OQDs] do want to, but if the climb is so steep…” P6 Several participants were not aware of the paid mentorship channels available to them and said the profession did not make access to mentors easy. However, one participant felt that mentorship was becoming more accessible now. “ I didn't even know that it existed something called as mentoring it's not very well communicated in our society” P3 Comparison with UK Graduates Multiple participants felt that mentors for OQDs were limited; they held a somewhat distorted view of their needs and perceived the group as a burden. Participants felt that mentors preferred UK graduates to them. “...every mentor assumes “I'm gonna have to handhold this dentist”, the perception is such that they're going to be a burden, [which] is completely unfair” P2 “What people likes to [mentor] is the British graduates. They take them first because we get funding for that but to supervise candidates who has taken ORE, we don't get funding” P5 “ So, we were two working in the same practice. She [UK graduate] had people to guide her with the portfolio, whereas I didn't, [support] was more focused towards [the UK graduate]” P7 Discussion Results from this study offered a window into the mentorship experiences of OQDs and how, in some cases, these interactions shaped their integration and work within the UK system. Participants overwhelmingly pointed at mentorship as an invaluable tool to adapt to dentistry in the UK. Participants perceived their mentors and their teams as unaware of what they knew or what support they needed, particularly regarding their integration, and some stated that they were expected to know everything as they were ostensibly experienced dentists in their home countries. As such, one participant described the importance of mentoring OQDs as individuals within their unique circumstances and cultural context, as opposed to merely requiring clinical support. This echoes other research 47 that highlights how mentoring within cultural context could be valuable. Evidence also endorses mentors who see cultural integration as essential to their role when supporting culturally diverse mentees 48, 49, 50 . This could be relevant to understanding how the scope of mentorship differs when supporting OQDs. Beyond the integration, participants highlighted the critical need for mentorship towards career growth and development, which is in line with the literature 51 focusing on IRNs and their career progression. Given the differences in roles and career paths of nurses and dentists, research into tangible strategies to enhance this cultural mentorship component for OQDs seems necessary 39 . This study found that regardless of the mentee’s needs, simply having a mentor was perceived as insufficient; a mentor who was either an OQD or understood the group’s challenges was crucial. Literature regarding overseas professionals advocates matching mentees to mentors from their backgrounds for this purpose 52, 53 . However, in this study, participants did not seem to require the mentor to be from the same culture as them. Other research 54 demonstrate the value of matching mentors with mentees, noting that matching needs may not always include background but other factors, such as matching work schedules. Although care needs to be taken regarding the transferability of their findings from a university in the USA to UK dental practices, their results are relevant in that factors other than shared background could ensure compatibility 55 . In fact, several participants advocated for mentor training on OQD support needs. Concurring with evidence that without training, only 30% of mentorship experiences would be positive, but with both mentor-mentee training, the success rate could be as high as 90%, it may be valuable to consider the role of mentor and mentee preparation towards more effective OQD mentoring programs 56 . Two participants who had inadequate mentorship experiences decided to move away from their organisations. This seems to concur with evidence that feelings of belonging or a lack thereof can greatly impact the retention of overseas professionals 51 . Others 57 highlight that the need to belong can be powerful, with reports that some student nurses admitted to accepting poor patient care standards in fear of rejection from their groups 58, 59, 51 . Considering the impact poor integration can have on staff retention and patient care standards, it is arguably not only the OQD that is affected but also their organisations and patients. Given that literature evidence suggests how pivotal mentors can be for increasing the sense of belonging, it seems sensible to consider ways to facilitate effective mentorship to aid professional integration 60, 28, 51 . Crucially, this study illuminates the need for mentors to understand the group’s challenges in some capacity. This mirrors the evidence on overseas anesthetists which describes how mentors need training to involve mentees in their learning, particularly given that overseas professionals are adult learners with pre-existing knowledge and unique needs 61 . Smith and Cantillon 62 similarly endorse the need for adequate training and support for nurse mentors when mentoring IRNs; which is later echoed 63 by advocating for involving IRNs in the development of their support programmes. It therefore seems sensible to similarly value OQD input and target research to this end. Complaints and Litigation Challenges Complaints and Litigation were dominant sub-themes in this study, and participants described mentors as valuable when they encountered complaints. Complaints and litigation are widely reported stressors across dentistry 64, 65 . Participants in this study reported how they viewed complaints and how it affected their wellbeing as most had not encountered serious complaints before in their home countries. Participants highlighted the crucial role of mentors in providing emotional support and assistance in helping to de-escalate and deal with such situations/challenges. However, rather than perceiving mentoring as merely a reactive tool, they also highlighted its value as a preventative measure. This links to data demonstrating that 66% of complaints arise from factors such as poor communication and that 80% of healthcare errors have been linked to non-technical factors including ineffective communication and teamwork 66, 67 . Research on IRNs suggests that their overrepresentation in FTP processes may be a manifestation of the lack of support frameworks for them 31 . Given that the latest GDC report considers offering targeted support interventions to overseas dentists, it is argued that results from this study confirms the need for this targeted approach. Furthermore, participants identified that mentorship was perceived as crucial in light of the government’s Provisional Registration proposal which may allow OQDs to practice without undertaking the ORE exam. These reforms could bring further challenges for OQDs according to indemnity organisations 68, 38 . Although the GDC considers it sufficient that OQDs would be supervised by a registered dentist during this initial period, several participants highlighted that, without adequate training, even experienced dentists may not be effective mentors for this demographic group. An effective mentorship program that meets the learning needs of both mentors and mentees has been advocated to safeguard OQDs, their mentors and patients 69, 38 . Systemic Challenges Many of the systemic challenges identified in this study align with the literature; for example, the difficulties in accessing NHS mentorship positions post-ORE, and OQDs’ subsequent moves to private practices 70, 39 . This potential clustering amidst the declining number of NHS dentists is concerning, as it can indirectly impact oral health inequalities in the UK 71, 72, 73 . However, contrary to the current literature discussing the exodus of dentists from the NHS, participants expressed a desire to work within the NHS and a sense of pride in delivering NHS care 74 . For instance, one participant valued the security of the NHS pension while another felt deterred by the pressures of private dentistry. “...I was looking into the NHS pension, [as] I knew the scheme is good” P8 An alternate explanation could also relate to participants’ ethical beliefs and commitment to public service 75 . Participants’ first-hand recounts of moving away from or struggling to join the NHS seem relevant given the current NHS recruitment crisis, raising the question of whether better access to NHS mentorship could influence NHS recruitment 74, 72 . Interestingly, those with positive mentorship experiences consistently expressed feeling luckier than their colleagues. This could be a feeling of being compelled to qualify their positive comments, knowing the rarity of supportive mentorship in their communities. This could also be explained as a negativity bias, given that, as humans, we tend to hold on to negative information far more than positive information as a critical adaptive evolutionary function 76 . Alternatively, research on refugees describes how power imbalances, feelings of distrust and not feeling heard could impact the reporting of experiences 77, 78 . Some participants noted the power their mentors possessed over them in interviews, an acceptance of exploitation within the NHS mentorship schemes and perceived threats of being referred to the regulators if they complained about their mentor 39, 70 . Literature on IMGs has also documented similar power imbalances, with IRNs having also potentially tolerated exploitation due to fears of losing their right to remain in the UK 79, 80 . It is possible that participants in this study felt an indirect pressure to project their experiences positively while expressing their negative experiences through their colleagues. Some participants perceived that UK graduates were favoured when it came to mentorship, which disadvantaged them in terms of access and the quality of support they received 70 . Since April 2023, the NHS mentorship scheme (PLVE) has been revised, wherein OQDs no longer have to pay their mentors 81 . However, participants reported that these challenges would likely remain despite those reforms, as the issues they faced were not limited to mentor payments but systemic funding pathway discrepancies whereby practices are renumerated for mentoring a UK graduate but not for OQDs 70 . These inconsistencies can render themselves to exploitative regimes such as lower remuneration, higher targets, lengthy contracts and hesitancy of mentors towards OQDs in general 39, 70 . This study also identified that OQDs seemed unaware of other available paid mentorship channels; many felt that the profession could make it easier to seek mentorship. This echoes literature advocating the need for incorporating mentoring at the organisational level within dentistry 82 . Others 12, 83 also highlight that mentorship is often poorly implemented in dentistry due to organisational ignorance of its systemic benefits and assert that effective mentoring crucially needs a fostering organisational culture. Conclusion and recommendations This study highlights the critical value of mentorship for OQDs, while acknowledging the challenges to its effective delivery. Given OQDs’ significant presence in the UK dental workforce, and the positive impact mentorship can have on individuals, organisations and patient safety, a collaborative and multi-level approach is essential 28, 51, 84 . Effective mentorship may begin with targeted induction programmes to support OQDs’ professional integration into the UK context, including cultural communication and unspoken norms. Mentors also require training to understand their multifaceted roles in supporting OQDs both within their cultural background and evolving workplace needs. Team-level training can further support OQD integration by encouraging shared responsibility, improving communication, and enhancing cohesion 84 . At a system level, organisations such as the NHS and regional deaneries may consider evaluating current mentorship pathways and exploring recruitment and retention strategies. Further research could also explore the potential role of an independent body to oversee mentorship, including pilot programmes for mentor recruitment and support. Indemnity providers might view induction and mentorship support as part of risk management, while the GDC could strengthen data collection to inform their upstream regulation approach 85 . Meanwhile, dental schools as well as coaching and mentoring organisations such as Dental Mentors UK 86 may contribute through innovative strategies to raise awareness of the long-term value of mentorship. Championing that mentoring has a crucial role in helping dental professionals enjoy and thrive in their careers in the UK, and its benefits are not merely limited to remedying deficiencies in clinical performance, or for NHS Performer list applications, could benefit OQDs and beyond. Such system-wide collaborative initiatives on how to seek mentorship could be crucial in encouraging OQDs to actively engage with any support networks available to them. Although mentorship is widely recognised across healthcare, evidence specific to OQDs remains limited. This study offers an important foundation for understanding the mentorship needs of OQDs and presents practical, multi-level recommendations that could support meaningful implementation and sustained workforce development. Additional Declarations There is no duality of interest Supplementary Files NaikWassifReferencesDec25.docx Bridging the Gap: Exploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 05 Jan, 2026 Review # 2 received at journal 03 Jan, 2026 Review # 1 received at journal 15 Dec, 2025 Reviewer # 2 agreed at journal 14 Dec, 2025 Reviewer # 1 agreed at journal 14 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor assigned by journal 11 Dec, 2025 Submission checks completed at journal 11 Dec, 2025 First submitted to journal 10 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Gap: Exploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study","description":"","filename":"NaikWassifReferencesDec25.docx","url":"https://assets-eu.researchsquare.com/files/rs-8329541/v1/80c0f91ba16b51d5982e7840.docx"}],"financialInterests":"There is no duality of interest","formattedTitle":"Bridging the Gap: \r\nExploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study","fulltext":[{"header":"Background","content":"\u003cp\u003eMentoring has various definitions in healthcare, but a widely accepted one is \u0026lsquo;helping another person become what they aspire to be\u0026rsquo;\u003csup\u003e1, 2\u003c/sup\u003e. Coaching is often used interchangeably with mentoring, and while they differ, both support personal and professional development\u003csup\u003e3, 4\u003c/sup\u003e. This study draws on literature related to both.\u003c/p\u003e \u003cp\u003eThe benefits of mentoring across dentistry and all aspects of healthcare have been well-documented\u003csup\u003e5, 6\u003c/sup\u003e with a particular focus on its value towards preventing burnout \u0026amp; attrition\u003csup\u003e3, 7\u003c/sup\u003e, enhancing performance\u003csup\u003e8\u003c/sup\u003e, supporting health, well-being, career progression\u003csup\u003e9\u003c/sup\u003e, and being a useful tool for workforce planning and retention\u003csup\u003e10, 3, 11, 12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMentoring has also been linked to reducing the sense of isolation among general medical practitioners (GPs)\u003csup\u003e13, 14\u003c/sup\u003e. Unlike multidisciplinary teams in hospitals, the institutional set-ups of dental practices in the UK have been likened to GP practices; Isolation has frequently been associated with daily dental practice\u003csup\u003e15, 12\u003c/sup\u003e. Holt and Ladwa\u003csup\u003e2\u003c/sup\u003e, therefore, have advocated for mentoring pilot schemes for general dental practitioners (GDPs) based on the comparable experiences of GPs.\u003c/p\u003e \u003cp\u003eOverseas Qualified Dentists (OQDs) encompass a significant and increasing proportion of the workforce in dentistry, 46% of new dentists on the 2022 General Dental Council (GDC) register were OQD\u0026rsquo;s\u003csup\u003e16\u003c/sup\u003e. The GDC has tripled the number of Overseas Registration Exam (ORE) places and is consulting on modernising examination routes for OQDs to increase numbers and remedy the COVID-19 backlog\u003csup\u003e17, 18, 19\u003c/sup\u003e. The GDC has not officially defined OQD\u0026rsquo;S whilst the British Dental Association (BDA) considers any dentist qualified outside the UK an OQD, regardless of their country of qualification\u003csup\u003e20\u003c/sup\u003e. As dentists emigrating from the European Economic Area (EEA) can currently register with the GDC without going through the ORE exam which is mandatory for dentists from the rest of the world; they are sometimes not considered OQDs\u003csup\u003e21, 22\u003c/sup\u003e. Nevertheless, given the language, culture and training differences compared to their home countries, it seems reasonable to concur with the literature\u003csup\u003e23\u003c/sup\u003e that EEA-qualified graduates face similar challenges to other OQDs and excluding them from the overseas category could ignore their support needs and skew critical evidence. Therefore, for this research, all dentists with a primary qualification outside the UK will be considered OQDs\u003csup\u003e24\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough research on OQDs in relation to mentoring is limited in the UK, OQDs in the USA and Australia have reported challenges such as structural barriers, discrimination, isolation and loss of identity\u003csup\u003e25, 26\u003c/sup\u003e. The need for support and value of mentoring in overcoming similar challenges is evidenced in research on International Medical Graduates (IMGs) and International Qualified Nurses (IRNs)\u003csup\u003e27, 28, 29, 30\u003c/sup\u003e. Research\u003csup\u003e31\u003c/sup\u003e identified that a lack of workplace support in facing acculturation hurdles could contribute to the overrepresentation of IRNs in FTP processes\u003csup\u003e32, 33, 34, 35, 36, 37\u003c/sup\u003e. Given that OQDs face relatively similar challenges and considering the recent Government consultation on provisional registration as an additional and alternative route for international dentists to work under supervision in the UK, understanding what effective mentorship means to OQD\u0026rsquo;s seems crucial towards supporting this group, their supervisors and their patients\u003csup\u003e38\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eData on OQD mentoring experiences is sparse and has been reported as informal and variable, with OQDs receiving mentorship through their communities or social media groups\u003csup\u003e39\u003c/sup\u003e. The differing needs for support and integration of migrant professionals have been well documented \u003csup\u003e25, 26, 28, 30\u003c/sup\u003e, however, similar data remains scant in dentistry, and the need to fill this gap in the literature is the rationale for this study. This study aims to explore what OQD s perceive as effective mentoring, and why, by examining their lived experiences. It also aims to explore areas in which OQDs perceive their needs for mentorship and their strategies in how to seek that support.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study focused on exploring participants' perceptions of mentorship experiences, therefore a qualitative approach was adopted to explore participants lived experiences\u003csup\u003e40, 41\u003c/sup\u003e with semi-structured interviews chosen as the data collection tool\u003csup\u003e42\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the University of Bedfordshire (Ref: 02/DLE/03/2024-2009679). Participants were recruited using purposive sampling focusing on OQDs who graduated during or after 2009\u003csup\u003e43\u003c/sup\u003e. Due to their experiential learning and integration through time, OQDs qualified over 15 years were excluded from the study. Participant information and consent forms were obtained from each participant and no incentives were offered for participation. Each participant (P) was designated a number P (1\u0026ndash;10) in order to maintain anonymity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eData collected provided a manageable yet rich source of qualitative data. Interviews ranged between 30 to 60 minutes with an average of 48 minutes. One-to-one, online, pilot interview took place for calibration and to refine interview techniques (not included in the final results), and questions and strategies were revised using structured feedback and reflection\u003csup\u003e44, 42\u003c/sup\u003e. Interviews were conducted, recorded and coded by the first author using Microsoft Teams. Transcribing the interviews formed the initial stages of the thematic analysis as it allowed the authors to immerse themselves in the raw data and to effectively observe the developed themes. Manual coding took place, with themes and subthemes later identified. Regular checks and reviews of interview techniques and practices were implemented throughout the study.\u003c/p\u003e \u003cp\u003eDuring the interviews, participants were presented with a collage of postcards portraying various experiences and emotions to augment data enrichment and to aid reflection about the topic\u003csup\u003e45\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTen semi-structured interviews were completed with 9 female and one male participants. Qualitative data was deconstructed with patterns and themes identified using Braun and Clarke\u0026rsquo;s six-phase framework thematic analysis using an interpretative paradigm\u003csup\u003e46\u003c/sup\u003e. Four themes were identified as follows: OQD and the mentor, OQD and the patient, OQD and the dental team and OQD and the wider system. Further subthemes were included within each individual theme and presented below.\u003c/p\u003e\n\u003ch3\u003eOQD and the mentor\u003c/h3\u003e\n\u003cp\u003eThe experiences of OQDs were variable, and subthemes were identified as part of participants' engagement with their mentors\u003c/p\u003e\n\u003ch3\u003eOverall Mentorship Experience\u003c/h3\u003e\n\u003cp\u003eNumerous participants expressed that their mentors lacked experience, understanding and training in mentoring OQDs. They felt it was critical to note that OQDs are a unique group with distinct needs, and the needs of each OQD differ within that group.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI was thrown in the deep end, it was quite hard and a bit challenging\u0026hellip;\u003c/em\u003et\u003cem\u003ehe mentor had no idea how much I knew or what I was expecting. My mentor expected that I knew everything and [that] I'm just gonna start\u0026rdquo;\u003c/em\u003e P1\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eI'm coming with one year experience or someone else is coming with ten years of experience. The mentoring needs of both clinicians will be very different\u0026rdquo;\u003c/em\u003e P2\u003c/p\u003e \u003cp\u003eMultiple participants described that mentors who were either OQDs themselves or those with experience of supporting OQDs were more likely to be effective mentors for this group.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eI think my mentor, because he was very experienced, [having] dealt with a lot of dentists from Iran, he kind of had the hack of how different dentists from different countries operate\u0026rdquo;\u003c/em\u003e P10\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eAn overseas dentist is obviously going to understand and could be a good mentor but also someone who have experience of seeing what [OQDs] struggle with can also be an effective mentor\u0026rdquo;\u003c/em\u003e P3\u003c/p\u003e\n\u003ch3\u003eProfessional and Personal Impact\u003c/h3\u003e\n\u003cp\u003e Participants described how their mentors impacted them professionally as well as personally, through the mentorship and beyond.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I joined the University thinking that I will do the PhD, but then [my mentor negatively] impacted my psychological and personal life that much that I had to stop at MPhil...I used to cry at the bus stops\u0026rdquo;\u003c/em\u003e P9\u003c/p\u003e \u003cp\u003e Multiple participants felt that mentors held a certain amount of soft power over them in the relationship.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eIf you don't like a mentor you still stick to it no matter what I think the fear is definitely there as well as a culture of respect and submissiveness to our seniors. [Mentors] have the power to use abuse or misuse that individual\u0026rdquo;\u003c/em\u003e P10\u003c/p\u003e\n\u003ch3\u003eValue of mentorship\u003c/h3\u003e\n\u003cp\u003eDespite their variable experiences, all participants felt that mentorship was valuable when starting work in the UK. Many highlighted that a mentor was also crucial for managing stress when things went wrong and career guidance was needed.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is not just clinical issues it should be...how you will personally deal with your stress\u0026rdquo;\u003c/em\u003e P5\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eYou need mentorship all the way through your life, even if you get the best mentorship even in the beginning of the years, you still face some challenges, having a mentor will definitely help in those situations\u0026rdquo;\u003c/em\u003e P3\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOQD and the Patient\u003c/h2\u003e \u003cp\u003eAll participants perceived patient care in the UK to be overwhelmingly different from their home countries. Many participants found treatment protocols, NHS payments based on Units of Dental Activity (UDA) and professional guidelines difficult to grasp. This theme focused on interactions with patients and their care, as well as how OQDs navigated the needs of their patients within a different system.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDelivering effective patient care in the UK dental system\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eWhat [OQDs] do need some advice is how to open plans, close plans on the NHS system, UDA contracts which are not done anywhere else in the world\u0026rdquo;\u003c/em\u003e P6\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eWe would just write [back home] not as much details as it is here, record keeping was the area that I was struggling [with]\u0026rdquo;\u003c/em\u003e P9\u003c/p\u003e \u003cp\u003e Various participants expressed that not being able to perform basic procedural tasks made them feel inadequate and that mentorship could be valuable towards combatting this.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Suddenly in the system you are feeling why are you struggling with things, which people say it's basis, so makes you feel a little incompetent which you are not\u0026ldquo;\u003c/em\u003e P10\u003c/p\u003e\n\u003ch3\u003eCommunication and Culture\u003c/h3\u003e\n\u003cp\u003e Communication was a dominant sub-theme, and nearly all participants commented on communication hurdles in varying forms. Most expressed that communication difficulties were not merely about English language fluency but cultural differences and colloquial slang. Cultural norms mattered; many words had different interpretations in their own country of origin, so understanding what the patient meant was difficult. While some were able to navigate these challenges mostly by observing their mentors over time, others felt let down by mentors in this regard.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Different parts of the UK, their slangs are different, so I did initially struggle\u0026rdquo;\u003c/em\u003e P3\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For example, back home, \u0026ldquo;you all right?\u0026rdquo; means you suspect something is wrong, and that's why you're saying you all right?, but here it is seen like \u0026ldquo;how are you?\u0026rdquo;\u003c/em\u003e P10\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eStarting from how to greet patients, [they] mean things in a different way [which], was difficult for me to understand.\u0026rdquo;\u003c/em\u003e P9\u003c/p\u003e \u003cp\u003e Furthermore, many participants said they were used to a different patient mindset; the concept of continuing preventative care, the critical need to build rapport with patients, involve them in their care, communicate consent, and its significance in the UK all seemed alien to them.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003ePatients [back home] come only when there is a problem, it's not preventive care. Over here, the culture of NHS is a different way of developing a rapport, so it does take a while to understand\u0026rdquo;\u003c/em\u003e P2\u003c/p\u003e \u003cp\u003e Participants frequently reported that communication barriers caused feelings of anxiety and fear which impacted their confidence, and therefore a mentor could be pivotal.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDealing with Patients Complaints\u003c/h2\u003e \u003cp\u003ePatient complaints and litigation were consistent stressors among participants; many expressed that complaints were not usually taken seriously in their home countries. Many reported feelings of panic and stress that substantially impacted their well-being, explaining the critical need for mentorship during these times, not merely as a reactive tool but also a preventative measure.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Most overseas dentists have never handled a complaint before, and they might take a complaint lightly but in UK complaints are taken very seriously so I think, in the initial years, [OQD\u0026rsquo;s] do need some direction\u0026rdquo;\u003c/em\u003e P6\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We never studied or worked in a system where we had to worry so much about defending ourselves all the time\u0026rdquo;\u003c/em\u003e P10\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eOQD and the Dental Team\u003c/h2\u003e \u003cp\u003e Several participants felt that a positive mentorship experience improved their teamwork skills, and some explained that mentors enhanced team cohesion.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eInitially, I used to be very limited in terms of the communication with my work team, but with the ongoing time in the mentorship...I'm more in touch with my whole team\u0026rdquo;\u003c/em\u003e P7\u003c/p\u003e \u003cp\u003e\u0026ldquo;...\u003cem\u003ewe have created the culture where we support each other. [Mentorship] has changed the entire way of working in the clinic\u0026rdquo;\u003c/em\u003e P2\u003c/p\u003e \u003cp\u003e However, multiple participants reported challenges like feeling misunderstood and struggling with cultural norms, which made them feel isolated even if they had clinical support from their mentors. Non-clinical mentorship support was considered valuable for overcoming some of these integration barriers within teams.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eEven though you have [clinical] mentors, nobody understood my culture there, I think having a mentor to just explain these kind of things to you [like] saying please, thank you, would have helped me embed into this system a lot more easily\u0026rdquo;\u003c/em\u003e P3\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOQD and the System\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eMentorship Channels\u003c/h2\u003e \u003cp\u003eChallenges in securing NHS mentorship positions were another recurring theme among participants. These included offers of low remuneration and exploitative mentorship contract terms, with some confirming that they had to pay mentors to acquire these positions.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eOnce I finished my ORE, finding the place for [NHS mentorship], that was a nightmare\u0026rdquo;\u003c/em\u003e P8\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I know quite a few who have struggled with getting a mentor. They either had to move cities or compromise to a lower income or another two year or five-year commitment or waiting three years before they can be mentored\u0026rdquo;\u003c/em\u003e P2\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI had to pay the mentor an agreed sum every month for 12 months, although my mentoring was only for nine months\u0026rdquo;\u003c/em\u003e P1\u003c/p\u003e \u003cp\u003eUnable to secure NHS mentorship positions, some participants resorted to work in the private sector.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThere is no dearth of mentoring in the private sector\u0026rdquo;\u003c/em\u003e P2\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThere is a sense of pride to work with the NHS and [OQDs] do want to, but if the climb is so steep\u0026hellip;\u0026rdquo;\u003c/em\u003e P6\u003c/p\u003e \u003cp\u003eSeveral participants were not aware of the paid mentorship channels available to them and said the profession did not make access to mentors easy. However, one participant felt that mentorship was becoming more accessible now.\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eI didn't even know that it existed something called as mentoring it's not very well communicated in our society\u0026rdquo;\u003c/em\u003e P3\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison with UK Graduates\u003c/h2\u003e \u003cp\u003e Multiple participants felt that mentors for OQDs were limited; they held a somewhat distorted view of their needs and perceived the group as a burden. Participants felt that mentors preferred UK graduates to them.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;...every mentor assumes \u0026ldquo;I'm gonna have to handhold this dentist\u0026rdquo;, the perception is such that they're going to be a burden, [which] is completely unfair\u0026rdquo;\u003c/em\u003e P2\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;What people likes to [mentor] is the British graduates. They take them first because we get funding for that but to supervise candidates who has taken ORE, we don't get funding\u0026rdquo;\u003c/em\u003e P5\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eSo, we were two working in the same practice. She [UK graduate] had people to guide her with the portfolio, whereas I didn't, [support] was more focused towards [the UK graduate]\u0026rdquo;\u003c/em\u003e P7\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eResults from this study offered a window into the mentorship experiences of OQDs and how, in some cases, these interactions shaped their integration and work within the UK system. Participants overwhelmingly pointed at mentorship as an invaluable tool to adapt to dentistry in the UK.\u003c/p\u003e \u003cp\u003e Participants perceived their mentors and their teams as unaware of what they knew or what support they needed, particularly regarding their integration, and some stated that they were expected to know everything as they were ostensibly experienced dentists in their home countries. As such, one participant described the importance of mentoring OQDs as individuals within their unique circumstances and cultural context, as opposed to merely requiring clinical support. This echoes other research\u003csup\u003e47\u003c/sup\u003e that highlights how mentoring within cultural context could be valuable. Evidence also endorses mentors who see cultural integration as essential to their role when supporting culturally diverse mentees\u003csup\u003e48, 49, 50\u003c/sup\u003e. This could be relevant to understanding how the scope of mentorship differs when supporting OQDs.\u003c/p\u003e \u003cp\u003eBeyond the integration, participants highlighted the critical need for mentorship towards career growth and development, which is in line with the literature\u003csup\u003e51\u003c/sup\u003e focusing on IRNs and their career progression. Given the differences in roles and career paths of nurses and dentists, research into tangible strategies to enhance this cultural mentorship component for OQDs seems necessary\u003csup\u003e39\u003c/sup\u003e. This study found that regardless of the mentee\u0026rsquo;s needs, simply \u003cem\u003ehaving\u003c/em\u003e a mentor was perceived as insufficient; a mentor who was either an OQD or understood the group\u0026rsquo;s challenges was crucial. Literature regarding overseas professionals advocates matching mentees to mentors from their backgrounds for this purpose\u003csup\u003e52, 53\u003c/sup\u003e. However, in this study, participants did not seem to require the mentor to be from the same culture as them. Other research\u003csup\u003e54\u003c/sup\u003e demonstrate the value of matching mentors with mentees, noting that matching needs may not always include background but other factors, such as matching work schedules. Although care needs to be taken regarding the transferability of their findings from a university in the USA to UK dental practices, their results are relevant in that factors other than shared background could ensure compatibility\u003csup\u003e55\u003c/sup\u003e. In fact, several participants advocated for mentor training on OQD support needs. Concurring with evidence that without training, only 30% of mentorship experiences would be positive, but with both mentor-mentee training, the success rate could be as high as 90%, it may be valuable to consider the role of mentor and mentee preparation towards more effective OQD mentoring programs\u003csup\u003e56\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTwo participants who had inadequate mentorship experiences decided to move away from their organisations. This seems to concur with evidence that feelings of belonging or a lack thereof can greatly impact the retention of overseas professionals\u003csup\u003e51\u003c/sup\u003e. Others\u003csup\u003e57\u003c/sup\u003e highlight that the need to belong can be powerful, with reports that some student nurses admitted to accepting poor patient care standards in fear of rejection from their groups\u003csup\u003e58, 59, 51\u003c/sup\u003e. Considering the impact poor integration can have on staff retention and patient care standards, it is arguably not only the OQD that is affected but also their organisations and patients. Given that literature evidence suggests how pivotal mentors can be for increasing the sense of belonging, it seems sensible to consider ways to facilitate effective mentorship to aid professional integration\u003csup\u003e60, 28, 51\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCrucially, this study illuminates the need for mentors to understand the group\u0026rsquo;s challenges in some capacity. This mirrors the evidence on overseas anesthetists which describes how mentors need training to involve mentees in their learning, particularly given that overseas professionals are adult learners with pre-existing knowledge and unique needs\u003csup\u003e61\u003c/sup\u003e. Smith and Cantillon\u003csup\u003e62\u003c/sup\u003e similarly endorse the need for adequate training and support for nurse mentors when mentoring IRNs; which is later echoed\u003csup\u003e63\u003c/sup\u003e by advocating for involving IRNs in the development of their support programmes. It therefore seems sensible to similarly value OQD input and target research to this end.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComplaints and Litigation Challenges\u003c/h2\u003e \u003cp\u003eComplaints and Litigation were dominant sub-themes in this study, and participants described mentors as valuable when they encountered complaints. Complaints and litigation are widely reported stressors across dentistry\u003csup\u003e64, 65\u003c/sup\u003e. Participants in this study reported how they viewed complaints and how it affected their wellbeing as most had not encountered serious complaints before in their home countries. Participants highlighted the crucial role of mentors in providing emotional support and assistance in helping to de-escalate and deal with such situations/challenges. However, rather than perceiving mentoring as merely a reactive tool, they also highlighted its value as a preventative measure. This links to data demonstrating that 66% of complaints arise from factors such as poor communication and that 80% of healthcare errors have been linked to non-technical factors including ineffective communication and teamwork\u003csup\u003e66, 67\u003c/sup\u003e. Research on IRNs suggests that their overrepresentation in FTP processes may be a manifestation of the lack of support frameworks for them\u003csup\u003e31\u003c/sup\u003e. Given that the latest GDC report considers offering targeted support interventions to overseas dentists, it is argued that results from this study confirms the need for this targeted approach.\u003c/p\u003e \u003cp\u003eFurthermore, participants identified that mentorship was perceived as crucial in light of the government\u0026rsquo;s Provisional Registration proposal which may allow OQDs to practice without undertaking the ORE exam. These reforms could bring further challenges for OQDs according to indemnity organisations\u003csup\u003e68, 38\u003c/sup\u003e. Although the GDC considers it sufficient that OQDs would be supervised by a registered dentist during this initial period, several participants highlighted that, without adequate training, even experienced dentists may not be effective mentors for this demographic group. An effective mentorship program that meets the learning needs of both mentors and mentees has been advocated to safeguard OQDs, their mentors and patients\u003csup\u003e69, 38\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSystemic Challenges\u003c/h2\u003e \u003cp\u003eMany of the systemic challenges identified in this study align with the literature; for example, the difficulties in accessing NHS mentorship positions post-ORE, and OQDs\u0026rsquo; subsequent moves to private practices\u003csup\u003e70, 39\u003c/sup\u003e. This potential clustering amidst the declining number of NHS dentists is concerning, as it can indirectly impact oral health inequalities in the UK\u003csup\u003e71, 72, 73\u003c/sup\u003e. However, contrary to the current literature discussing the exodus of dentists from the NHS, participants expressed a desire to work within the NHS and a sense of pride in delivering NHS care\u003csup\u003e74\u003c/sup\u003e. For instance, one participant valued the security of the NHS pension while another felt deterred by the pressures of private dentistry.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;...I was looking into the NHS pension, [as] I knew the scheme is good\u0026rdquo;\u003c/em\u003e P8\u003c/p\u003e \u003cp\u003eAn alternate explanation could also relate to participants\u0026rsquo; ethical beliefs and commitment to public service\u003csup\u003e75\u003c/sup\u003e. Participants\u0026rsquo; first-hand recounts of moving away from or struggling to join the NHS seem relevant given the current NHS recruitment crisis, raising the question of whether better access to NHS mentorship could influence NHS recruitment\u003csup\u003e74, 72\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInterestingly, those with positive mentorship experiences consistently expressed feeling luckier than their colleagues. This could be a feeling of being compelled to qualify their positive comments, knowing the rarity of supportive mentorship in their communities. This could also be explained as a negativity bias, given that, as humans, we tend to hold on to negative information far more than positive information as a critical adaptive evolutionary function\u003csup\u003e76\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlternatively, research on refugees describes how power imbalances, feelings of distrust and not feeling heard could impact the reporting of experiences\u003csup\u003e77, 78\u003c/sup\u003e. Some participants noted the power their mentors possessed over them in interviews, an acceptance of exploitation within the NHS mentorship schemes and perceived threats of being referred to the regulators if they complained about their mentor\u003csup\u003e39, 70\u003c/sup\u003e. Literature on IMGs has also documented similar power imbalances, with IRNs having also potentially tolerated exploitation due to fears of losing their right to remain in the UK\u003csup\u003e79, 80\u003c/sup\u003e. It is possible that participants in this study felt an indirect pressure to project their experiences positively while expressing their negative experiences through their colleagues.\u003c/p\u003e \u003cp\u003eSome participants perceived that UK graduates were favoured when it came to mentorship, which disadvantaged them in terms of access and the quality of support they received\u003csup\u003e70\u003c/sup\u003e. Since April 2023, the NHS mentorship scheme (PLVE) has been revised, wherein OQDs no longer have to pay their mentors\u003csup\u003e81\u003c/sup\u003e. However, participants reported that these challenges would likely remain despite those reforms, as the issues they faced were not limited to mentor payments but systemic funding pathway discrepancies whereby practices are renumerated for mentoring a UK graduate but not for OQDs\u003csup\u003e70\u003c/sup\u003e. These inconsistencies can render themselves to exploitative regimes such as lower remuneration, higher targets, lengthy contracts and hesitancy of mentors towards OQDs in general\u003csup\u003e39, 70\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study also identified that OQDs seemed unaware of other available paid mentorship channels; many felt that the profession could make it easier to seek mentorship. This echoes literature advocating the need for incorporating mentoring at the organisational level within dentistry\u003csup\u003e82\u003c/sup\u003e. Others\u003csup\u003e12, 83\u003c/sup\u003e also highlight that mentorship is often poorly implemented in dentistry due to organisational ignorance of its systemic benefits and assert that effective mentoring crucially needs a fostering organisational culture.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion and recommendations ","content":"\u003cp\u003eThis study highlights the critical value of mentorship for OQDs, while acknowledging the challenges to its effective delivery. Given OQDs’ significant presence in the UK dental workforce, and the positive impact mentorship can have on individuals, organisations and patient safety, a collaborative and multi-level approach is essential\u003csup\u003e28, 51, 84\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEffective mentorship may begin with targeted induction programmes to support OQDs’ professional integration into the UK context, including cultural communication and unspoken norms. Mentors also require training to understand their multifaceted roles in supporting OQDs both within their cultural background and evolving workplace needs. Team-level training can further support OQD integration by encouraging shared responsibility, improving communication, and enhancing cohesion\u003csup\u003e84\u003c/sup\u003e. At a system level, organisations such as the NHS and regional deaneries may consider evaluating current mentorship pathways and exploring recruitment and retention strategies. Further research could also explore the potential role of an independent body to oversee mentorship, including pilot programmes for mentor recruitment and support. Indemnity providers might view induction and mentorship support as part of risk management, while the GDC could strengthen data collection to inform their upstream regulation approach\u003csup\u003e85\u003c/sup\u003e. Meanwhile, dental schools as well as coaching and\u0026nbsp;mentoring organisations such as Dental Mentors UK\u003csup\u003e86\u003c/sup\u003e may contribute through innovative strategies to raise awareness of the long-term value of mentorship. Championing that mentoring has a crucial role in helping dental professionals \u0026nbsp; enjoy and thrive in their careers in the UK, and its benefits are not merely limited to remedying deficiencies in clinical performance, or for NHS Performer list applications, could benefit OQDs and beyond. Such system-wide collaborative initiatives on how to seek mentorship could be crucial in encouraging OQDs to actively engage with any support networks available to them.\u003c/p\u003e\n\u003cp\u003eAlthough mentorship is widely recognised across healthcare, evidence specific to OQDs remains limited. This study offers an important foundation for understanding the mentorship needs of OQDs and presents practical, multi-level recommendations that could support meaningful implementation and sustained workforce development.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8329541/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8329541/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eOverseas qualified dentists (OQDs) make up a significant portion of the UK dental workforce, yet there is limited research on their experiences, particularly regarding their mentorship needs. This study explores OQDs\u0026rsquo; perceptions of mentorship, its value, and effectiveness, with the aim of informing evidence-based recommendations to better support this group.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative research approach was adopted, involving ten in-depth semi-structured interviews with OQDs who had registered in the UK within the last fifteen years. The interviews, totalling approximately eight recorded hours, were analyzed using thematic analysis with an inductive approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFour key themes emerged from the data. The first theme, OQD and the Mentor, captured participants\u0026rsquo; overall mentorship experiences, highlighting, the benefits and their unmet needs. The remaining three themes addressed specific challenges faced by OQDs: OQD and the Patient, which explored logistical, cultural, communication, and litigation-related difficulties; OQD and the Dental Team, which examined team dynamics and professional integration; and OQD and the System, which identified systemic barriers within the UK dental sector.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eWhile OQDs recognized mentorship as highly valuable, their experiences varied widely, with many reporting significant challenges. Given the substantial role OQDs play in the UK workforce, their mentorship experiences not only affect individual career progression but also impact team cohesion, workforce retention, and patient care. Understanding these challenges is essential for developing targeted mentorship strategies that support the growth and development of the workforce.\u003c/p\u003e","manuscriptTitle":"Bridging the Gap: \nExploring Mentoring Needs of Overseas Qualified Dentists: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 13:29:16","doi":"10.21203/rs.3.rs-8329541/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-01-05T23:42:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-01-04T02:49:03+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-12-15T18:38:55+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-15T00:45:38+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-14T15:52:35+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-12-12T17:59:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-11T08:28:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-11T08:28:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"British Dental Journal","date":"2025-12-10T16:18:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"924d5af4-80b2-4f1b-b659-dc61a7400d28","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59573473,"name":"Health sciences/Health care/Dentistry/Dental education/Dental post graduate education"}],"tags":[],"updatedAt":"2026-05-07T17:25:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 13:29:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8329541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8329541","identity":"rs-8329541","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}