Development and Assessment of a Leadership Program for Dentistry Students

doi:10.21203/rs.3.rs-2377208/v1

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Development and Assessment of a Leadership Program for Dentistry Students

https://doi.org/10.21203/rs.3.rs-2377208/v1

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Introduction:

The emergence of disparate opportunities and challenges in the twenty-first century emphasizes the importance of leadership training in dentistry. Therefore, a reflective, interactive, and collaborative training workshop in this field can positively improve the pioneer dentists' knowledge, mindset, and skillset.

Aims

This article aimed to share the foundation of the leadership program, design expected outcomes, evaluate the program's effectiveness in a dental school in Iran, and discuss the importance of leadership skills for dentistry students.

Design:

We conducted a program design and research evaluation based on a mixed-method approach. A two-day leadership development program was developed and held in Alborz dental school in Karaj, Iran. A group of 20 dentistry students participated in the program. Then, the program was evaluated twice, once just after the program and once six months later,

Results

90% of the participants rated the course 4 or higher (4.5 on average) on a 5-point satisfaction scale, in which 1 meant utterly dissatisfied and 5 meant completely satisfied. The highest average score was for the Leadership from Inside-out module (4.55 of 5). In addition, the students rated teamwork practice as the most challenging part and presentation skills as the most influential module of the program. Furthermore, according to this survey, 80% of the students will participate in future leadership programs with high satisfaction, and 95% of the students recommended it as an extra-curricular activity for all students in dental school.

Conclusion

The program's facilitators provided an exceptional opportunity and psychologically-safe environment for students to learn leadership skills. Training leadership as non-clinical skills can be beneficial for dentistry students, and it can positively affect the dental profession and ultimately effective healthcare systems. Therefore, including voluntary leadership courses in undergraduate and postgraduate dental curricula is recommended.

Leadership

Dental Education

Dentistry

Leadership Training

Leadership represents a mixture of traits and behaviors that a leader has, which enable the followers' participation, development, and commitment to achieve a common goal. It is defined as a "process whereby an individual influences a group of individuals to achieve common objectives" to "change for the greater good" (1–3). Leadership skills refer to traits defining a good leader in individual aspects such as charisma, intelligence, creativity, self-confidence, and interpersonal factors such as working in a team, problem-solving, and decision-making skills (4). In 1977, Zalzenick published an article that indicates management is rational and systematic, but leaders achieve changes by inspiring and motivating their team to move toward a vision (5).

The new dental practice model moves from solo dental practice toward group practices with multiple dental practitioners. The emergence of large group practices requires dentists to develop leadership and other collaborating skills (6–8). Many cannot afford to take time away to re-educate themselves within the practice. In addition, many do not necessarily know about changes in the surrounding system because of too much focus on managing their practice contracts and their small business (9).

Although leadership in dentistry has not gained much attention, it can guide oral health professionals to a more productive health care system (9–11). In contrast, continuing education focusing on leadership and management is more available for our medical colleagues. Leadership courses for medical leaders were executed when hospitals realized that creating buy-in with their staff required different types of skills rather than clinical skills gained through MD degrees (12). Very little has been researched on the changes taking place in the dental profession with the help of leadership. Therefore, this subject can be further studied because the school years can inspire, encourage, and enhance the leadership skills of future dentists (13).

Regarding this topic, a study at Case Western Reserve University showed that 99% of dental students agree on the importance of leadership skills (10). However, while studies support the need for leadership courses for general practitioners, dental students who enter the working world have never received any leadership training. Furthermore, much of the training available for trainee dentists has focused on teaching management rather than leadership skills (14).

The authors hypothesized that a fully developed, well-organized, and interactive workshop on this topic would positively affect the knowledge and skills of future leader dentists. Therefore, in this study, a course was designed to evaluate participants' satisfaction with a novel leadership course, contents, and instructions and observe the impact of the course on participants' leadership competency for the first time in Iran. This article aims to assess the effectiveness of a leadership course and discuss the importance of leadership skills next to clinical skills for dental students.

Course design

The experts in leadership designed the two-day workshop plan specifically tailored to teach essential leadership knowledge and skills needed in the healthcare sector. Course participation was opened to all dental students, but it was intentionally limited to 20 participants to foster in-depth small-group discussions, significant group engagement, and practical teamwork activities. All the participants received a certification upon completion of the program. The first day of the program included: Participants' introduction, the difference between Leadership and management, Team building activities, Leadership from Inside-out: personal values, and social identities.

The second day included: Practicing creativity and innovation, leadership from a communication perspective: Interpersonal communication and effective presentation skills, and a reflective personal visioning exercise.

The course's overall objective was to introduce the concept of "leadership," increase awareness and give necessary tools to dental students to apply to their work. In addition, specific objectives were for students to gain a better understanding of the following concepts:

The difference between management and leadership skills

Emotional intelligence and its relationship with self-awareness, self-regulation, empathy skills, and social skills

The importance of having teamwork skills and their application to have an effective team

The idea that personal values impact leadership styles

To have the opportunity to create a unique vision

During the workshop, a series of books on leadership were available for students to further their knowledge.

In the following, an overview of the modules covered in the course is provided.

Module 1: Participants' introduction

The program started with a participant introduction, using an engaging creative conversation. They were given a set of visual cards and were asked to pick a picture that represented how they defined leadership. Visual cards were a powerful tool to encourage authentic conversations and effective dialogue in a safe learning environment. This set of visual cards uses diverse images to create a visual vocabulary that helps participants express themselves through stories, metaphors, intuition, and emotion. Given the cultural diversity of the participants, their interpretation and conceptualization of effective leadership were slightly different. However, the common fundamental themes described were vision, strategy, and direction for effective leadership.

Module 2: Difference between Leadership and Management

This module was designed to highlight the differences between management and leadership. As Bennis summarized, "managers do things right, while leaders do the right thing" (15). The instructor presented slides about these two concepts and introduced the different aspects of leadership and management. The role of emotional intelligence was also argued in the workshop. The skills required for a leader were discussed based on Goleman's study (16).

Module 3: Leadership from Inside-out

This module focuses on self-awareness and a deeper understanding of self as a leader. Individuals must reflect on themselves, their core values, strength, behavioral patterns, aspirations, goals, and developmental plans. The self-reflection approach included Boyatzis's theory of Intentional Change Model learning (17). This model offers five discoveries, and each of them serves as the starting point for a learning process. Taken together, they provide a coherent and integrated model that supports an intentional personal development plan as a guide to move towards action.

These discoveries were as follows:

My ideal self (who do I want to be?)

My authentic self (who am I?)

Building on my strengths while reducing gaps

Experimenting with new behaviors, thoughts, and feelings and practicing them

Developing trusting relationships that help and support each step

To enable each participant to find out about his authentic self, the facilitators give them a list of values and ask them to prioritize them based on their values. Finally, the module concluded with discussions about 1) self-awareness, 2) self-regulation, 3) self-motivation, 4) empathy, and 5) social skills underpinning other approaches to leadership. Students also came up with situations where dentists should be careful about their emotional aspects of leadership roles. Such skills are considered crucial since health care leadership is more than a practice; it is also an interpersonal interaction. There may be a movement away from practice owners' historical emphasis on autocratic leadership styles toward a more democratic team-based leadership style.

Module 4: Personal Vision

Participants were also introduced to the concept of creating a personal vision. They were asked to do a reflective exercise to explore their personal and professional vision. According to Kotter, vision represents a leader's capability to perceive the future accurately and increases motivation and responsibility to achieve a goal (18). As described in "In A Whole New Mind" by Daniel Pink, being a synthesizer is vital to dental education leaders. Being a synthesizer means seeing the big picture, crossing boundaries, and combining disparate pieces into an arresting new whole (19).

Module 5: Team building games/activities

The third module was dedicated to the concept of building a team environment, led by the facilitator and a co-facilitator. This environment was created through the practice of teamwork practices. At the end of the activities, each delegate shared his own experience. The objective was to understand each other's roles in teamwork and how building a trusting team environment can decrease mistakes and improve task effectiveness. Despite the solitary nature of dental practice and the mentality of many dentists, even the smallest dental practice setting is a teamwork environment, and networking is likely to be a new way of working for those who historically have operated as autonomous practitioners in their own small business.

Module 6: Creativity and innovation

This module on creativity and innovation aims to prepare participants for the constantly changing work and life environment as we know it. The key considerations for this section were the ability to think outside the box, create new visions and solutions, and adapt to the uncertainty and complexity of challenges they face in their workplace and with their teams. In addition to sharing best practices in this module, practical games and group discussions were used to enhance the learning. Participants were encouraged to see challenges and opportunities with fresh eyes and practice creativity and innovation as a key skillset in their leading change.

Module 7: Effective presentation skills

In this module, the focus was on leadership from a communication perspective. The importance of knowing the audience, and the ability to have clear and effective communication was discussed. Often, leaders have a great vision, but only those who can present their vision are able to succeed. This section included characteristics and requirements of effective presentation and offered tips on public speaking with high impact. Verbal and non-verbal communication, executive presence, and how it affects a leader's capacity to influence, inspire, and motivate others were explained. Participants were then asked to practice presenting a topic of their choice to the whole group and received feedback on improving this skillset.

Course Assessment

A mixed-method (qualitative/quantitative) approach was used with open-ended and closed-ended questionnaires and an in-person interview to evaluate whether the students found value in this pilot program. The course was anonymously evaluated twice, one right after the workshop (initial survey) and the other six months after (follow-up survey), to obtain a broad scope of feedback. The study protocol was exempted by the Alborz University of Medical Sciences Institutional Review Board.

The first feedback sheet was designed to see whether the participants had found value in this experience, mentioning the most challenging and the most influential part of the course while rating each part of the plan on a scale of 1 to 5 (1: completely dissatisfied − 5: completely satisfied)

The follow-up survey consisted of two parts. In the first part, the qualitative data was collected using an in-person interview; the students were asked about their experience during six months in dental school and how they used the gained skills, providing a self-reflection opportunity. In the second part, participants completed another feedback sheet; they had to prioritize the five most essential leadership skills required for a dentist to be included in future leadership programs. Finally, the students were asked about their preferences and needed for a future leadership course.

Ethics

The study protocol was approved by Alborz University of Medical Sciences Ethics committee and all the methods were carried out in accordance with relevant guidelines. Informed consent was obtained from all participants and their names and information remained confidential.

A total of 20 students participated in the study, of whom 8 (40%) were male and 12 (60%) were female. Among them, 2 (10%), 2 (10%), 7 (35%), and 9 (45%) were studying in the first, second, third, and fourth year of school, respectively.

Initial survey

Twenty feedback sheets were gathered from the participants right after the workshop. The majority of the participants found the course satisfying (30%) or completely satisfying (60%) (mean score: 4.50 of 5), believing it met their expectations. In addition, of the seven modules they were asked to evaluate, leadership from inside-out (4.55 of 5), effective presentation skills (4.45 of 5), and participant's introduction (4.40 of 5) received the highest average scores, respectively (Fig. 1).

The most challenging part for 13 students (65%) was practicing teamwork and activities. Presentation skills were the most influential session for nine students (45%).

Follow-up survey

Following six months after the course, all participants completed another feedback survey consisting of two parts. The first part was about their experience of applying leadership knowledge in their personal and dental student routines.

The following quotes are some of the students' opinions from the first part of the follow-up survey.

"The course helped me use my body language for presentations in a better way. Furthermore, it helped me identify my strengths and weaknesses. Finally, the course content helped me communicate within a team to lead a dental team including patient and dental personnel more effectively."

"This workshop showed me the practical strategies for giving a good lecture, especially for a larger audience in the future. In addition, the course enabled us to work effectively as a team and continue practicing teamwork in my future career."

"As a student, the most valuable aspect of this course was how it opened my eyes to my values. It was a chance for self-awareness. I am grateful that I had this opportunity to practice leadership for the first time at my dental school. We learned the basics of leadership and its difference from management. I believe that it would be great to have another leadership workshop to learn how to be a dentist leader."

"I gained a greater appreciation of the importance of communication. The course provided small group exercises that would help me be a leader in my small private dental office. It would be better to have another leadership workshop on bridging the gap to apply this knowledge into the dentistry field."

"I enjoyed the passionate facilitators and experts in leadership training. Small group exercises helped me improve my teamwork skills with my peers. I would have enjoyed it more if there was a specific topic on being a small private dental office leader in this workshop. I am willing to lead and change the attitudes of dental staff while still maintaining the main vision."

According to the students' opinion, negotiation skills, conflict management, problem-solving skills, emotional intelligence, and teamwork were the five most critical leadership skills in dentistry. Strategic planning, vision development, Ethics, critical thinking, and professionalism were ranked in the following levels.

Besides, results from the follow-up survey showed that 80% of the students would like to participate in the future leadership courses with high satisfaction, and 95% prefer it as an extra-curricular course offered in dental school for all the students.

The quote "Change is inevitable. Growth is optional" by John C. Maxwell shows us that old ideas cannot be contained and must give way to a new vision to make growth happen (1). As technology progresses and our technical, social, and behavioral systems become more complex, differences grow dramatically in delivering oral health care. These changes demand professional skills in prevention and treatment and leadership and human relations skills to improve health and the quality and efficiency of health care. Leadership skills are especially crucial for strengthening healthcare systems to deliver services to broader society and address their needs (20–25). Furthermore, dentists are practitioners and policy-makers, public health directors, and educators today and tomorrow. They must have strategic thinking and adaptation consistently to ensure the sustainability of oral health care systems (26–30). Suppose dentistry embraces no leadership role in the recently integrated care systems. It will be disregarded in the decision-making processes not intentionally but because of the absence of representatives (30). Hence, the vital question is how our profession should address the characteristics of a leader since it will not happen by mere chance. In published papers, it has been argued that leadership can be taught and trained. Educators and educational programs play a crucial role in learning a plethora of consummate skills and creating future leaders (31–35).

Although the need and desire for leadership development programs have been studied, only a few active programs for this field exist globally. There is a novel opportunity to develop a pedagogically robust leadership education; thus, the collaboration between university professors and practitioners is essential (36–38). Although successful implementation and evaluation of leadership skills may not be easily possible, future programs can examine how different leadership programs can affect students' attitudes and may allow the development of a gold standard for such extra-curricular programs to maximize students learning outcomes (39, 40).

A survey by Morison indicated that professional leaders within dental services see a significant lack of opportunity to develop dental leaders. They suggested that management and leadership skills be provided at the undergraduate level. Nonetheless, it has been reported that leadership development at earlier career stages, particularly during predoctoral education, has received insufficient attention (24). According to Bedi et al., the undergraduate level is the best time in the dental career to develop leadership skills, allowing them to burgeon alongside clinical skills. Some clinical skills such as communication, empathy, and problem-solving may overlap with leadership in an integrated way. However, proper training is necessary for all dentists, both undergraduate and postgraduate levels. Leadership must be considered an essential role that all dentists should learn and not be limited to those working in management or organizations (35).

Dental leaders and dental students have expressed an interest in leadership programs in different studies. In a survey by Victoroff et al., almost all students agreed on the importance of leadership skills for dentists and claimed they expect to take part in leadership roles. A high proportion showed interest in participating in a leadership program if it existed (10). In 2008 another study across the US demonstrated that dental students find leadership development programs beneficial (41).

Different universities have organized various programs in this field. In an eleven-week course at the University of Southern California School of Dentistry, participants were taught the most relevant leadership skills and helped to discover their leadership style (42). In another pilot leadership program for dental students at the Case School of Dental medicine, the program consisted of topics responsive to students' reported preferences. The majority of the participants found it beneficial and stated that they would participate in similar future programs (43). In 2010, a nine modules leadership course was offered to the postdoctoral dental students at Harvard School of Dental Medicine. Students evaluated the course positively (4.71 of 5) and gained a perception of team dynamics and their leadership strengths and limitations with the help of case studies, role-play, and self-reflection (44). Finally, a dentistry leadership program aiming to prepare dental students for leadership roles in their profession and community was implemented at the University of Michigan. The volunteer participants gave positive feedback about the program and considered recognition in the profession, participation in the community, and efficiency in practice as indicators of leadership (45).

To the best of our knowledge, this was the first leadership program held for a group of dental students in Iran, and this topic and its importance in dental education has not been studied before. Participants strongly found leadership skills crucial in their studies and future work environments. According to the qualitative data gathered from the follow-up survey, we could shape an environment that has created an exceptional learning opportunity that positively affects students' attitudes.

Although generic leadership skills are required for both medical and dental practices and other fields such as research, education, public health, and areas related to practice management, dentists must step up and explore wider boundaries of clinical leadership. It is argued that many characteristics that contribute to a dentist's success conflict with good leadership skills (4). Leaders move towards an objective while working with their team, whereas a dentist has to do minimal negotiation to persuade their team or external stakeholders. Dentists work alone with very little feedback from colleagues and other health care professionals, which contrasts with innate skills that help a good leader. Leaders' operation is in a transformational style, meaning that they know their team members individually, inspire them, and identify their values to achieve organizational objectives. However, dentists mainly thrive in transactional environments, meaning they tell their staff and their patients what to do, and compliance is the reason for a good outcome (4, 46).

We are aware that our research may have a few limitations worth mentioning. First, the small sample size did not allow us to perform multiple comparisons. Second, student opinions have limitations but are acceptable to obtain feedback to improve curricular interventions. One strategy to enrich students' experience would be providing students with multiple and differently structured programs, which would significantly impact students' attitudes. Finally, a lack of related and reliable data and a limited number of leadership courses offered in dental schools worldwide required us to limit the scope of our analysis. The increasing collaboration between dental professionals across the countries suggests further research on this topic and offers more related courses across the globe.

Present research findings and the review of the related literature demonstrated that teaching leadership skills as a non-clinical skill is beneficial for dentistry students and will positively affect the dental profession. However, when practicing dentistry as a self-employed professional, most dentists cannot afford to take time away from practice to re-educate themselves in new concepts. Accordingly, we suggest including voluntary leadership courses in the undergraduate and postgraduate dental curricula to teach them the necessary non-clinical skills. Providing a structured framework of methodology and infrastructure of support, such as these courses for dental students, is essential to achieving positive changes in our patient care.

Acknowledgement: We extend our sincere thanks to Clinical Research Development Unit of Dental School, Alborz University of Medical Sciences for sincere collaboration.

Conflict of interest statement: None

Ethics approval and consent to participate: Mentioned in the text by the ethics heading.

Consent for publication: Not applicable.

Availability of data and material: The datasets analyzed during the current study available from the corresponding author on reasonable request.

Funding: None.

Conflict of Interest: None declared.

Author’s contribution: A.D, P.T and A.E were involved in the conception and research design. P.T and H.S did the data collection and interpretation. All authors wrote the manuscript draft and approved the final version.

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No competing interests reported.

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Version 1

posted

You are reading this latest preprint version

Development and Assessment of a Leadership Program for Dentistry Students

Status:

Version 1

Abstract

Introduction:

Aims

Design:

Results

Conclusion

Figures

Introduction

Methods And Materials

Course design

Module 1: Participants' introduction

Module 2: Difference between Leadership and Management

Module 3: Leadership from Inside-out

Module 4: Personal Vision

Module 5: Team building games/activities

Module 6: Creativity and innovation

Module 7: Effective presentation skills

Course Assessment

Ethics

Results

Initial survey

Follow-up survey

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1