Introduction

The Overseas Registration Examination (ORE) is one of the two dental examinations that allow overseas-trained dentists (OTDs) with dental qualifications outside of the United Kingdom (UK), European Union (EU) or European Economic Area (EEA) to register with the General Dental Council (GDC) in the UK. The alternative examination is the Licence in Dental Surgery (LDS) which is organised and run by the Royal College of Surgeons of England. Any OTDs who successfully pass either of these examinations have met the minimum standards required to work safely as a dentist in the UK.1,2

The number of overseas-trained health professionals, especially medical doctors, joining the UK workforce has risen significantly in the last two years.3 However, this is not the case with their OTD counterparts; in fact, the number of OTDs outside of the EU/EEA region joining the UK dental workforce has been reducing.4 This is because an OTD is not recognised and certified to join the dental workforce until either the ORE or LDS examination is passed. Both the ORE and LDS have similar structures. The examinations are in two parts and aim to test candidates' knowledge, skills and competence regarding dentistry.1,2,5,6 Nevertheless, the ORE appears more popular among OTDs than the LDS. Therefore, this opinion piece will focus on the ORE.

There is a differential pass rate between the ORE parts 1 and 2. Figures from the GDC website2 show that the pass rate for part 1 between 2016-2019 ranged from 57-78%, whereas the range for part 2 over the same period was 25-67%. Song5 stated that the differential pass rate between parts 1 and 2 can be attributed to the different format of the examinations. For instance, the ORE part 1 is a computer-based examination that is essentially multiple-choice questions, while part 2 is designed for candidates to demonstrate their clinical knowledge and skills.2,5

To the best of my knowledge, there is no published research which has investigated candidates' views on the ORE. However, concerns have been raised about the ORE, especially the part 2 examination. These concerns have often been expressed on the Freedom of Information (FOI) platform.7,8,9 These range from: issues around booking the examination; reliability of the results; examination cost; examiners' conduct during the exam; feedback and comments provided after the examination; and many more. The GDC have always provided answers to questions posed by candidates on the FOI platform; however, anecdotal evidence shows that candidates' concerns remain the same. The most recurring complaint about the ORE part 2 is related to booking to sit the examination, which has been the case in the last two to three years.7,8,9

This opinion piece presents personal arguments about booking the ORE part 2. This is based on personal viewpoints, discussions among other OTDs, anecdotal evidence and 'snapshot' analyses. It is hoped that this paper will provide an understanding of the booking process of the ORE part 2, its benefits and drawbacks, and suggestions that will make booking the examination a better experience for candidates and will also be beneficial to the GDC. Overall, it may inform the GDC and other similar professional dental bodies conducting examinations for OTDs.

Exam booking

One of the essential toolkits to successfully pass any examination is adequate preparation. Generally, dental examinations have a reputation for being demanding and stressful.10 Other factors may also affect OTDs, such as cultural shock, fear of the unknown, fear of acceptability, family separation, loneliness, isolation and many more, leading to a more challenging experience in their transition into the UK dental workforce.

Prior to 2017, the ORE part 2 was conducted six times a year, with a capacity for 100 candidates. In May 2016, only 82 candidates booked the examination and this led to the GDC reducing the annual number of examinations conducted from six to three, with the capacity increased from 100 to 144. This is a 28% reduction in the number of examination slots annually, which has subsequently created a high demand for the part 2 examination.

Furthermore, the ORE part 2 is booked online through the GDC portal and is based on a 'first come first served' basis on a stipulated day within a certain timeframe. All eligible candidates for part 2 are informed ahead of the date and time the online portal will be open. However, the current high demand for the ORE part 2 and the low pass rate means than more OTDs are contending for the limited available examination slots. Thus, this current booking system does not guarantee candidates getting an examination slot.

'Snapshot analyses' of candidates indicate that the ORE part 2 booking closes mostly within two minutes of the online portal being open and therefore it is those with a fast internet speed who manage to secure an examination slot. Considering that the majority of OTDs may not currently be residing in the UK but rather live in low-income countries with less than average internet facilities, this puts such candidates in a disadvantaged position with regards to securing an examination booking. Ultimately, this may make such candidates ease up on their preparation until another booking opportunity arises.

There are scenarios in which candidates have tried booking the examination repeatedly but were unsuccessful in securing a slot. Such candidates imply that the booking is based on 'chance' or 'luck'. Anecdotally, some colleagues have indicated that they attempted to book the examination more than twice before successfully securing a slot. Consequently, it becomes draining for candidates after many failed attempts, especially those who are ready to sit the examination. This may subsequently dwindle candidates' level of preparation due to the uncertainties surrounding booking a slot and this may be associated with the low pass rate noted regarding the ORE part 2.

As with all examinations, the time required to prepare differs from candidate to candidate. However, on average, many colleagues have indicated that it takes about four to six months to adequately prepare for the ORE part 2. Most of the time, there is around a two-month gap between booking a slot and the examination date. In situations where candidates have eased up on their preparation due to a series of unsuccessful bookings, a successful booking with two months' preparation time usually puts a lot of strain on such candidates and may increase their levels of stress and anxiety.

Having a 'first come first served' booking system means that candidates who secured a slot were the first to book the examination. This implies that unprepared candidates should not attempt to book the examination. Moreover, the GDC states that this examination booking style is more efficient and cost-effective because it avoids the problem of over-provision and financial loss.8

The GDC gives all candidates a five-year limit to complete the ORE part 2 after successfully passing part 1. It is reasonable, therefore, that the GDC contacts candidates who are near the five-year limit to give them the opportunity to attempt part 2 at least four times before the expiration of this period. These candidates are given a 'priority' booking option and do not go through the normal booking route. Candidates with this 'priority' option usually have more than the two-month window between booking and examination dates. For instance, anecdotal evidence from candidates who sat the January 2020 examination shows that there were about 25 priority candidates, which amounted to about 17% of the total candidates.

Furthermore, the UK exiting the EU (due to Brexit) may also impact on booking the ORE. At the moment, dentists who qualify in EU/EEA countries are allowed to join the dental workforce without taking the ORE. The outcome of UK negotiations with the EU will determine if this current trend will continue or not. Nevertheless, if EU-qualified dentists must sit the ORE, this will increase the demand and further calls for changes in the booking of the examination, especially part 2.

Moreover, the current COVID-19 pandemic made the GDC suspend the ORE for the year 2020 and only one out of three scheduled examinations have been conducted. This is because it is very challenging to conduct some aspects of the examination in line with COVID-19 guidelines; for instance, the dental manikin and medical emergencies examination. This has subsequently created a backlog of candidates waiting to sit the examination. Hence, it is now more imperative to address issues surrounding booking the ORE part 2, bearing in mind there will be more candidates willing to sit the examination.

The GDC objective is that the demand for the ORE especially part 2 continues to outweigh supply. Furthermore, the GDC stated that their current legislation puts constraints on increasing examination capacity.8 Nevertheless, if candidates do not consider this booking style to be beneficial, it would be practical for the GDC to explore other booking options. Hence, this opinion piece aims to make recommendations about booking the ORE part 2. The purpose of the recommendations is to create a win-win situation for both the GDC and candidates.

Recommendations

This opinion piece aims to critically discuss win-win suggestions that are beneficial to both the GDC and to ORE part 2 candidates, with regards to booking the examination. Several suggestions have emerged from discussions with other candidates, such as: having regional centres where examinations are conducted; having candidates resit only the failed component on a separate date; outsourcing the ORE to another dental professional body; provision of other alternative examinations like the LDS; and many more. However, this opinion piece will only discuss two suggestions that would improve examination booking.

The first recommendation is to increase the number of examinations conducted annually. The GDC has made it clear that the Order of Council (2015) restricts their ability to increase the annual number of examinations conducted.8 Nevertheless, in view of the current high demand for this examination and the backlog from suspending examinations due to the COVID-19 pandemic, it will be more pertinent and suitable for the GDC and the Order of Council to consider revising the current booking strategy to make it more responsive and flexible to candidates' needs.

This is the reason I will suggest that the ORE part 2 is conducted at least four times annually, with a capacity for 144 candidates per examination. This recommendation will increase the current candidate capacity by 24% - although this is still 4% short of the pre-2017 capacity. Furthermore, this should be cost-effective and provide a win-win situation for both the GDC and candidates. This is because it should be less expensive for the GDC to conduct four ORE part 2 examinations annually as opposed to six examinations pre-2017. It should be noted that this proposed increment need not be rigid and, if at any time the demand for the ORE part 2 reduces, the GDC can revise the yearly capacity (and vice versa if demand continues to rise).

The second recommendation is to make all the dates of the ORE part 2 available up to a year ahead so that candidates can have the opportunity to choose their preferred date. However, there should be a clear cancellation policy. For instance, once a candidate books a preferred date, they are not able to get a refund except in extenuating circumstances backed with evidence. The policy should explicitly state the deadline for presenting such extenuating circumstances with evidence and the proportion of the refund a candidate is able to claim (such as half or a quarter of the examination fee). As there is a high demand for the ORE part 2, it is highly likely that there will be a waiting list. In scenarios where there is a cancellation due to extenuating circumstances, then candidates on the waiting list can be contacted to take up the available examination slot.

Having both a clear cancellation policy and waiting list should prevent financial loss to the GDC, as it helps them to prepare efficiently for candidates registered for each examination date. Moreover, it can be assumed that all examination dates will be filled because of the high demand for the ORE part 2. This recommendation does not defeat the 'first come first served' basis of booking the examination, but does allow candidates to be more purposeful with the booking and adequately prepare for the examination as deemed fit. Ultimately, these proposed recommendations may improve the ORE part 2 pass rates.

Summary

The ORE remains a popular route for OTDs to enter into the UK dental workforce. However, anecdotal evidence, snapshot analyses, discussions with candidates and written complaints indicate that the booking process for part 2 of the examination is a major concern among candidates that requires revision. Moreover, the current COVID-19 pandemic and potential impact of Brexit further calls for a revision of the booking process. The recommendations discussed in this paper should benefit both the GDC and candidates.