The Importance of Leadership Skills in Dental Education

Introduction

Relationships amongst healthcare professionals, allied service providers and patients, are dynamic and in a constant state of flux. Several external forces continue to shape the dental profession including; changing demands and therapeutic options; commercialization of dental services and products and tremendous increase in the access to information in the public domain. Other challenges include: the need for sensitivity to cultural practices, patient safety, function efficiently in a team framework and address disparities in oral health. Dentists are required to manage efficient small businesses and complex staffing issues, while planning for an uncertain future. Thus, a new graduate is thrust into an ever changing environment with a necessity to constantly adapt.

A dental student may eventually end up choosing to extend services into various fields including: private solo or group practice, government or private administrative positions in; education, public health, research, or community service. Each field presents its own set of problems. Dental education faces serious challenges in the form of; escalating costs and corresponding student debt, faculty shortage and curricula that have often failed to keep abreast with the current environment. Epidemiological data has also highlighted targeted disparities in the oral health of disadvantaged populations such as minority children, the elderly, and individuals with special health care needs. While a large population of dentists are solo practitioners, a perceptible change towards group practices can be noticed and there is a need for dentists to develop hitherto neglected skills such as robust leadership, negotiation and collaborative skills. Clinicians are primarily trained in clinical expertise but are eventually required to assume management responsibilities. Thus, sophisticated leadership skills, attitudes, and abilities are necessary to navigate the clinician manager role successfully.

In the context of the several roles being asked of the dental student to play and in the face of the significant challenges being faced by the dental profession, proactive leadership seems to be lacking. Within this environment dentists may be exposed to undue stress on account of the fact that leadership attributes and skills required to successfully negotiate these circumstances may be missing or inadequate. Leadership skills are not necessarily inherent to dentists and formal training in leadership is the need of the hour. Arguably, leadership is a complex and difficult skill to develop and paradoxically leadership in dentistry remains one of the most neglected in comparison to the other clinical professions with very little research conducted on the impact of leadership in dentistry. It is imperative that dental professionals participate in the process of redesigning their future plans to arrive at a new vision and mission that includes an expanded role to embrace the entire dental team.

One of the important measures to ensure that dental health care professionals fully address current and future changes, is to educate them to be future leaders. An effective dental leader ensures employee satisfaction, provides opportunities to be role models and agents of change within their local communities. Leadership development at earlier career stages, is the optimal way for "early identification and purpose¬ful development of leadership talent, interest, and abilities". Studies demonstrate that both faculty/administrators and students appreciate the value of and need for student leadership development.

What is Leadership

The viewpoint of what leadership means is an area of considerable debate. Leadership has been considered an activity, not a position and may even be fleeting, in-the-moment interventions. Thus, leadership in dental education means mobilizing others to make progress on difficult issues.

"Leadership entails the effective communication of a vision (whether shared or not) and an honest and in-depth evaluation of collective experiences and/ or available data so that organizational change may occur in a rational manner". A collaborative, shared leadership style, with core concepts including " leadership as a trait, leadership as an ability, leadership as a skill, leadership as a behavior and leadership as a relationship" has been advocated as a suitable definition of leadership in dentistry.

Though frequently clubbed together, differences between leadership and management exist which need to be noted. The essential difference is that leadership means leading by example whereas management is focused on implementation in the best possible way.

How To Go About Developing Leadership Skills

The role of a dental school and the traditional curriculum in the context of leadership, mostly refers to the development of technical and scientific skills. However, formal leadership training programs that focus on helping students learn how to successfully build a team, communi¬cate effectively, and enhance decision making skills, must be considered as a critical mandatory learning opportunity. Moreover, the program must entail universal student participation rather than a select few, since a potentially diverse range of situations may see the emergence of leaders from least expected sources. A general set of attributes are thought to be necessary for the development of leadership skills.(Table No1.) A leadership development program may do well to enhance personal and organizational learning opportunities taking into consideration the leadership style of the individual.

Personality / traits, behavioral style, situational /contingency and transformational leadership are some of the well known theoretical approaches to leadership. However, there is no consensus about the most appropriate leadership theory or approach, either in general terms, or specifically in relation to dental surgeons. Nevertheless, a practical and more popular mode is the competency approach in dental education.

Competencies for Leadership

Competencies define what skills and knowledge are required for the job. Leadership as a competence can be defined as the process of manag¬ing and serving as an advocate to help others achieve particular outcomes. Leadership competence in a clinical or research setting can focus initially on the knowledge and concepts of leadership. A set of competencies, not exclusive to dentistry, have been deemed essential to achieve leadership skills.

Team Building: Communication and Conflict Management

The importance of communication skill development as a cornerstone for leadership cannot be understated. In clinical practice, research or community service, aspects such as; motivating stakeholders, networking, negotiations, conveying point of view and disseminating information, competence in communication skill(both verbal and non verbal) may be the differentiating factor between success and failure. Indeed, students perception reflects that they desired’ more’ on communication skills inspite of having been administered a module on communication. Communication exercises designed to mimic difficult real life situations and a framework to deal with them can help students enhance their communication skills.

Dentistry as a profession has a responsibility to address not only the problems normal/privileged populations, but also cater to the needs of underserved communities and populations. The communities as well as the students learning dentistry come from diverse cultural backgrounds. Effective team building requires, at least in part, cultural awareness while providing patient care, working together as part of the oral health care providers team or during interprofessional interactions. Ability to trust and conflict management are additional components of team building that can be taught preferably by discussions and team projects. Conflict management ability is developed by individually evaluating the five conflict-handling modes, or styles—competing, collaborating, compromising, avoiding, and accommodating and then discussing the most appropriate style for a given situation. Overall, formal teamwork training has been shown to be effective in improving team behaviors, reducing errors, and improving staff attitudes.

Ability for Self-Reflection/self Awareness

One of the most important characteristics of communication is the ability to share a vision that most ef¬fectively comes from self-reflection and is often the by-product of self-directed learning. Understanding one’s own approach highlights the differences that are inherent to team functioning and increases selfawareness and empathy.

Critical Thinking and Problem-Solving Skills

Critical thinking is regarded as intellectually engaged, skillful, and responsible thinking that facilitates good judgment because it requires the application of assumptions, knowledge, competence, and the ability to challenge one's own thinking. Though researchers debate if critical thinking can be learned, instructional strategies can influence what is learned:

1. simulation-driven learning experiences that require application of the reflective judgment process
2. Frequent use of questions by instructors that require students to analyze problem etiology, compare alternative approaches, provide rationales for plans of action, and predict outcomes;
3. Listening to the reasoning of expert practitioners as they “talk through” their approaches to analyzing and solving problems;
4. Comparing data searching steps, strategies implemented, decisions made, and outcomes to that of expert practitioners who work through the same case scenario; and
5. Writing assignments that request students to analyze problems by discussing theories about causal factors, compare alternative solutions, and defend decisions about proposed actions.

To develop critical appraisal skills, students must have time to reflect and think critically. Fostering the ability to ask many questions, focusing on issues or circumstances that provoke a passionate response and take existing ideas or concepts and bring them together in novel ways are habits that overtime can enhance the critical thinking process..

Ethics

Ethical leadership is imperative and indispensable; nevertheless, knowledge alone will not prepare students for the potentially complex situations they may face in their routine professional life. Case-studies with thorough discussions on the ethical principles applied along with acceptable alternatives are needed to grasp students attention. Interplay between legal aspects and ethics are needed to comprehensively prepare students with an armamentarium to deal with real life situations. Academic institutions and the various stakeholders such as faculty and administrative staff are also required to set an example of ethical behavior to be emulated by students in their future professional endeavors.

Professionalism

Professionalism may be defined as a life characterized by display of high intellectual, technical, and moral qualities and abilities, in service to patients and community. Professionalism is and must be an integral part of student education and lifelong learning. Nevertheless most professional attributes in dental education are acquired as a byproduct of completing the curricular requirements and not by focused dedicated instruction. Additionally, reports of unprofessional behavior by dentists, broad changes in society and modified policies of regulatory bodies has led to an increased educational interest for the concept of professionalism which in turn has led to a greater focus on ways of implementing and assessing professionalism in dental, medical and other professional educations.

Assessing Leadership Competence

The leadership skills may be taught as a set of modules or as a separate leadership development program. Either approaches may then ultimately be reflected in terms of competencies. Indeed dental educators are emphasizing on the development of leadership skills, as reflected by dedicated competencies to be achieved by the graduating dentist. (Table No. 2)

The assessment methods frequently utilized to evaluate competency in leadership skills include: MCQ’s, essays, extended matching questions, orals, research projects,OSCE, self and peer assessment. As with other domains, leadership is best assessed using triangulation; a process where onecan obtain data of student learning from three different sources, thereby ensuring sufficient data is collected in order to evaluate student learning.

Conclusion

The dental profession needs to treat every single graduating and graduated dentist as a potential leader. These skills are essential in a scenario where the very basis of terming dentistry as a profession is being questioned, with calls to brand it a business. Technical skills development is being focused on, but leadership training is sadly lagging behind. Dental schools and curricula represent the best opportunity to start training a future generation of dentists who will be well equipped to deal with these dynamic challenges, even as leadership programs for graduated dentists is on the rise. It would be an inspiring beginning if at least the authorities associated with regulating dental professions in different countries initiate a discussion in the very least, on the means of implementing leadership development programs in dental schools.