Dental hygienist Plamena Mya, from Bulgaria, moved with her family to Scotland in 2011. In 2021 she graduated with a first class degree in Business Management from Robert Gordon University, Aberdeen. She is now undertaking two further courses concurrently: a BSc in Data Science and an MBA in Management and Operations, with a longer term goal to use her knowledge and skills to enhance and expand prevention in oral health.

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Interview

Where are you from originally?

I am from Bulgaria but 'Eastern Europe' is my usual answer nowadays. Often in the past, when I said 'from Bulgaria' I could see silent puzzlement ('Bulgaria?') on people's faces. I also lived in Poland for a good few years.

When did you move to Scotland and why?

I moved to Scotland with my family on 15 July 2011 - straight after my graduation as a dental hygienist - because my husband had got a job in Aberdeen. We have two daughters who are now 22 and 18 and university students.

Back in 2011 the one-way flight from Gdansk to Glasgow was the completion of a lengthy process of planning and preparation, and also the beginning of a new challenge. It had been my long-standing dream to live and work in the UK but to do it seemed almost impossible for us due to a number of serious bureaucratic and economic obstacles.

Apart from my husband's job, an obvious reason for the move was to apply my new qualification in practice because sadly in Poland the demand for dental hygienists was negligible at that time.

Also, in the early 2000s, I had a small e-commerce start-up, which was doing well and was convenient for a stay-at-home mum. However, since I read the book Who moved my cheese?1by Spencer Johnson,I understood that change is unavoidable: things don't stay the same. The logical conclusion then is to embrace change and even seek and initiate it.

What were your ambitions when you left secondary school?

Straight after secondary school I was admitted to study medicine in Varna, Bulgaria. I was elated that my grades were just high enough not to fall into the dentistry cohort. And where did I end up?... joke or irony of fate.

Now that I am in three independent practices with great teams, and having significant experience and knowledge, I do enjoy treating patients, especially because the majority of them see and feel the improvement afterwards and come back regularly.

I enjoyed my medical studies… until I went to an actual hospital for experience-building. What I saw is what Dr Eric Topol calls 'shallow medicine', which is, for example, focusing overwhelmingly on the so-called 'surrogate end points'. A holistic approach was absent and there was 'mass medicalisation' (See The creative destruction of medicine2 and Deep medicine3). There was curing, but no healing. My disillusionment with the 'real-world' practice of medicine coincided with a turbulent political and economic period in Bulgaria, so the only sensible thing seemed to be to leave both for good, promising myself that at some point I would return to higher education.

How did you get into dentistry?

A busy dental practice in Gdansk, Poland, was looking for a trainee dental nurse, so I applied and was successful. It was supposed to be something temporary, but it turned out to be about four years of dental nursing, working in different practices alongside very experienced clinicians, watching and learning.

When and how did you qualify as a dental hygienist?

Six months after I started my very first job in dentistry, a new dental school opened nearby and I enrolled for the part-time dental hygiene course, while still working full time as a dental nurse. I couldn't help but be inspired and motivated by the idea of becoming a clinician myself, rather than simply supporting clinicians.

After two years of juggling nursing during the week and fortnightly weekend workshops, I graduated with a diploma recognisable within the European Union. However, my dental hygiene education continued with a number of courses required for General Dental Council (GDC) registration in the UK, for instance, extended duties (local analgesia, temporary dressings, impressions taking), BDA Radiography, smoking cessation advice, etc. In retrospect, gaining GDC registration was probably as challenging and stressful as gaining my vocational diploma.

Can you summarise your career working as a dental hygienist?

I was fortunate enough to secure a position in two very good practices soon after my GDC registration on 10 October 2012. One practice was owned by two partners and the other by one principal dentist. Overall, as soon as the practices I worked at started changing hands, my working life became more volatile, uncertain, and stressful. Initially, I thought I would change the place and/or spread the risk by working across multiple practices. However, eventually I decided that the time had come to gain my long-overdue degree.

Do you enjoy treating patients as a dental hygienist?

Now that I am in three independent practices with great teams, and having significant experience and knowledge, I do enjoy treating patients, especially because the majority of them see and feel the improvement afterwards and come back regularly. I particularly value the ethos of prevention - fundamental for my job - and which is so brilliantly highlighted by Mr Phil Ower, former President of the British Society of Periodontology (BSP), in his and Mr K. Eaton's book Practical periodontics.4

What made you decide to study for a BA(Hons) Business Management course in Aberdeen?

My prompt to apply for this course was that in a relatively short time period, a number of major changes occurred at my main practice, affecting the conditions of my day-to-day job. My keen interest was to learn more about the drivers behind those changes. The excellent recently published book Dental law and ethics5 by Len D'Cruz and Raj Rattan confirmed the correctness of my choice because the dental business landscape is indeed fascinating.

Additional motivation came from the observation that there didn't seem to be much in the way of career prospects for a dental hygienist with just a diploma. So, I needed both a higher qualification and more knowledge.

How did you find the course?

My university experience was mostly positive. Overall, I learned perhaps more by reading around the topics in the curriculum than through the materials provided. My approach was that the onus is on self-study and the course provides the general direction of learning. Last year I finally gained my first class honours degree, having straight As in the final two years. For one module I created an idea for a dental-related start-up and wrote a business plan for it. Then I market-tested it and it worked well enough to prove the concept. On the Project Management module, I took part in the Spaghetti Marshmallow Challenge, which is great for team collaboration skills building. My dissertation analysed some aspects of the accelerated pace of digital transformation and organisational change within the NHS during the COVID pandemic through the lens of the Prospect theory (Tversky and Kahneman)6 and Giddens' Structuration theory.7

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Flight over Loch Lomond

Did you continue working as a dental hygienist during your studies?

Yes. Thanks to many universities adapting to the changes brought by digital technology, I was able to have a blended mode of study - mostly online with monthly on-campus workshops. Also, being a self-funded student, it probably would have been unaffordable, had I left my work.

I live relatively close to the university and a once-a-month commute was never a problem, especially back then when the fuel was still reasonably priced.

Are you excited to be studying two further full time university courses?

It is a blend of excitement and a healthy dose of stress at the moment. In fact, one of the courses, the BSc Data Science, I started in February, and it has been very mentally stimulating. The topics in the later years sound fascinating but first we have to get some good grounding in maths, statistics and simple coding.

My younger daughter starts university this September, and my older daughter is starting the final year of her degree, which gives me more time for my studies.

How is it possible to study two full time courses? It sounds very demanding!

Again, they are mostly online (it's a blessing!), which of course requires a lot of self-discipline. However, it will only be six months that the two courses will run parallel, hopefully without interfering. Preparation and planning are key and that's what I'm focusing on this summer, learning - for example - Python and economics.

True, it is demanding: many think it cannot be done. I don't know unless I try it. I'm trying to work backwards from this target - what do I need to do to make it possible? It is important to achieve it (with a more lenient approach to grades) because it is, hopefully, something that will to some extent differentiate me - set me apart from others - and will provide me with a rare combination of experience and qualifications.

Why do you want to study these particular courses?

The Master of Business Administration course is a logical continuation of my degree. It is also a well-established, valued qualification across many sectors, which is an important consideration for the uncertain times we live in.

I learned about the Data Science course by chance. However, I was already very interested in this field having read the Deep medicine book.3 Here is just a sentence to illustrate the idea:

'The triad of deep phenotyping - knowing more about the person's layers of medical data than ever previously attainable or even conceived - deep learning and deep empathy can be a major remedy to the economic crisis in healthcare by promoting bespoke prevention and therapies, superseding many decades of promiscuous and wasteful use of medical resources.'

My love for flying led me to gaining a Private Pilot Licence for single-engine planes in 2015. I was even dubbed "The Flying Hygienist" by some patients.

I didn't plan to apply for a Data Science course but I have a strong conviction about its synergies with the MBA course. Whether we like it or not, technology is everywhere and gets ever more complex but it is also expanding the boundaries of what is possible. For example, when I left secondary school, I couldn't dream that there would be a time when degrees could be gained remotely from far-away universities without ever setting foot in them. Thanks to technology, I'm able to learn online while keeping my day job.

So you will still be able to work part time as a dental hygienist?

It won't be easy, and my working hours will fluctuate for a while, but I'm hoping to continue seeing patients, although in reduced capacity. The project concluding my MBA degree will discuss the links between business and digital in a dental context.

Can you share your long-term goals/plans post-graduation?

In the current uncertainty and volatility, it is difficult to make long-term plans. When I was studying to become a dental hygienist, I had no idea how, where or when I'd find a job. Moving to the UK, newly qualified, was a leap of faith. Thankfully, it worked out thanks to very special people that believed in me and I'm forever grateful to them. I'm hoping for something similar this time too.

Mainly, I would like to make a difference on a greater scale than I currently do. Mr Phil Ower quotes MacKintosh: 'Everybody says that prevention is better than cure and hardly anyone acts as if they believed it'. So, ideally, I would like to be involved in 'prevention on digital steroids' and helping people 'make sustainable lifestyle changes through behavioural change management techniques'.8

After such a long period in higher education, might you consider a career in academia?

I am considering it. It always comes down to the people rather than places.

Do you have time for other hobbies or interests?

Time is in a short supply at the moment, so I can't actively pursue my hobbies. My love for flying led me to gaining a Private Pilot Licence for single-engine planes in 2015. I was even dubbed 'The Flying Hygienist' by some patients. For a while, I was considering whether this skill could be used for a dental charity wanting to reach remote places but due to my other commitments, I couldn't pursue it. I truly enjoyed flying; I even had some (returning) passengers but it is certainly on hold at the moment, as are my painting and hiking.

When I can I enjoy city breaks: the last one was to Venice in the summer of 2019. I also like using our cat as a warm, fluffy stress ball.

Any special plans this summer?

A few days with my family in the Italian Alps at the foot of Mont Blanc.

Interview by Kate Quinlan

Editor's note: If any reader shares Plamena's ideas on expanding prevention, she would be pleased to hear from them and can be contacted via k.quinlan@nature.com.