Preparing the next generation of dental leaders: a scoping review

Preparing the next generation of dental leaders: a scoping review | 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 Preparing the next generation of dental leaders: a scoping review Igor Blum, Christopher D. Lynch, Nairn Wilson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8823910/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Objective: With ongoing uncertainty about how dental leadership should evolve to meet future real-world challenges, this rapid scoping review evaluated existing literature to identify strategies that most effectively develop leadership skills in dentistry. Methods: Multiple sources (MEDLINE, AMED, EMBASE and Google Scholar) were searched using terms relating to ‘healthcare’, ‘dentistry’, ‘leadership’, ‘effectiveness’, ‘development’, ‘education’, ‘training’ and ‘programmes’. Records were screened for relevance; eligible sources informing the aim were included. Findings were interpreted and reported using narrative synthesis principles. Results: Evidence was diverse but centred on leadership development. Dentistry is often described as relying on hierarchical, authoritative and managerial approaches, which may limit the development of future leaders. Education and training at pre- and post-registration levels were consistently highlighted as ways to transition toward leadership models shown to work elsewhere in healthcare, including transformational and participative leadership. These styles may enhance quality of care and patient safety, optimise staff wellbeing, and sustain workforce capacity and competence. Conclusions: Leadership is fundamental to care quality, patient safety and workforce resilience. Despite strong regulatory, professional and policy emphasis, evidence remains limited regarding which leadership styles and development methods are most effective in dentistry. Future research should address these gaps by evaluating theory-informed dental leadership development programmes and their impacts. Health sciences/Health care/Dentistry/Dental education/Dental post graduate education Figures Figure 1 Figure 2 Figure 3 Key Points Leadership is critical in dentistry for patient safety, quality of care, and workforce sustainability. Current dental leadership is often hierarchical/managerial, and a shift toward more collaborative, transformational approaches is recommended. Leadership training is needed at pre- and post-registration levels. Introduction The role and value of leadership within the healthcare professions is continuing to gain importance, given research to support associations between leadership and enhanced quality of care and patient safety. 1 Within dentistry, however, the role and value of leadership remains less well understood, posing uncertainty over education and training programmes designed to develop the next generation of dental leaders. 2 This is despite the General Dental Council (GDC) emphasising the importance of leadership for various responsibilities within its standards of practice, including: prioritising and maintaining patient safety, upholding infection prevention and control, evidence-based practice, promoting effective teamworking, and assessing staff performance in relation to ethical principles, professionalism and scopes of practice. 3 National policies in the United Kingdom (UK), such as the National Health Service (NHS) Long Term Plan, seek to reform the health system and its various services, including dentistry through enhancing integrated care. 4 Should stakeholders fail to provide appropriate leadership, there is a risk that dentistry and the dental profession will be excluded from policy reforms, potentially resulting in adverse future challenges, ranging from deteriorating population dental and oral health, increasing difficulties in accessing dental services 5 and dentally related aggravation of chronic non-communicable diseases, such as diabetes. The dental profession is expected to adopt multi-disciplinary models of care, integrating state-of-the-art expertise in various disciplines to address patients’ varied needs. This requires effective leadership, specifically in the effective delivery of complex care. 6 Such leadership, in contrast to leadership at the national or health system level, requires leadership skills at the community and individual service levels. 5 There is evidence to suggest that leadership is lacking within the dental profession. In an opinion paper, Nalliah 7 highlights that the majority of dentists work in isolation or within small teams and, as a consequence, tend to acquire management as opposed to leadership skills. This is reflected in observations that dentists largely use authoritative, directive and assertive styles to delegate tasks and manage service provision. As a result, dentists face significant challenges in becoming effective leaders, as the skills they develop through experience tend to be in conflict with those required of effective leaders. 7 In addition, the many dentists attracted to the profession by the autonomy of practice a lack the traits and external influences associated with effective leadership. 8 Such problems have been identified in the United States, where a survey of dentists showed that leadership is valued but lacking in practice, in part, given barriers such as time constraints, lack of leadership education, and a paucity of leadership training programmes. 9 This survey showed also that engagement in leadership activities was suboptimal by 40% of the 593 dentists who participated (9). In another survey, Taichman et al. 10 reported that up to two-thirds of dentists felt that poor readiness for leadership in practice was the result of omissions in education and training at the undergraduate level, and <70% indicated that post-registration experience was an important driver to engage in leadership. In the UK, a similar picture has emerged with a mixed methods study showing that leadership among dentists is variable and often founded on hierarchical, non-collaborative and individually-centric styles, linked to frustration among members of dental teams, specifically a lack of involvement in decision making. 11 Staff also perceived leadership hierarchies as barriers to the translation of guidelines and a deterrent to maintaining evidence-based practice. 11 Also, failures and challenges in developing effective leaders in dentistry have been noted within the academic field, where women seeking leadership positions encountered obstructions related to insufficient mentoring, training and sponsorship. 12 Thus, there is an apparent lack of inclusion and representation of effective leadership across dental hierarchies, contributing to ineffective leadership at the practice level. Developing effective leaders in dentistry is pivotal to supporting patient safety and continuous quality improvement processes. This is based on empirical evidence demonstrating associations between leadership dimensions and measures of patient safety, care quality and staff wellbeing. 13,14 In addition, evidence noting such associations within healthcare may also harbour applicability to the dental profession, given shared nuances of practice and factors influencing patient outcomes. 1 Given the leadership imperative in dentistry, there is a need to understand the ways in which the profession can support the development of effective leaders to sustain and, where possible, improve quality of care and clinical outcomes in the future. This rapid scoping review aimed to address this issue by evaluating the pre-existing literature. The objectives of this review were to identify the effective means of developing effective leaders and to formulate recommendations for ongoing leadership development practices, related policies and future research. Methods Scoping reviews are credited for providing rapid insights into novel construct areas through enabling the evaluation of numerous and broad evidence sources. 15 Considering data and opinions from differing sources is often needed in situations where primary empirical evidence may be lacking and/or methodologically challenging to conduct, consistent with the topic of interest. The search for literature sources was conducted using a range of information mediums, including core electronic databases including, MEDLINE, EMBASE and AMED, and Google Scholar. 16 A broad search was conducted to help capture all key sources of information, helping to generate a rigorous insight into the strategies for developing effective clinical leaders. The search terms were based on key phrases including ‘healthcare’, ‘dentistry’, ‘dental’, ‘leadership’, ‘leaders’, ‘effective’, ‘development’, ‘education’, ‘training’, and ‘program’. The captured records were screened for relevance, and those contributing value towards the review aim were included in the following narrative synthesis. The process of narrative synthesis was suited to evaluating the findings due to the inclusion of varied sources and the related excess heterogeneity that emerged. 17 The synthesis was interspersed with a critical appraisal of the literature, seeking to promote objectivity in reporting. 18 In addition, a discussion of wider related literature has been included to generate broader relevance and validation of the positive and less positive findings. 17 Results In an account provided by Blum 19 , leadership in dentistry is described as being at a significant crossroads; this is illustrated in Figure 1. Dentists are required not only to manage teams, but also to exercise leadership to sustain high-quality care in the context of increasing complexity and systemic pressures, while navigating ethical and regulatory demands, diverse patient needs, and emerging digital technologies. It has therefore been argued that, without the development of more effective leadership capability, the dental profession may be unable to meet the needs of future populations. Blum 19 initially suggests that challenging pre-existing assumptions and narrow lenses of leadership is a key first step. Conventionally, leaders in dentistry have naturally emerged as a result of extensive practice experience and adopting the most senior statuses within practices, mitigating opportunities for others who may have traits and skills conducive to effective leadership theories and styles; those that lack authoritative or overly assertive approaches. 19,20 Blum 19 states that effective leadership demands less focus on hierarchy and greater attention in fostering inclusive and supportive relations and cultures, conforming to transformational and participative styles of leadership, which have been extensively investigated in healthcare and have been associated with favourable outcomes. 21 As a consequence, Blum 19 argues that developing future dental leaders demands several strategies: reflective practice, effective communication skills, emotional intelligence, supportive and empowering staff on personal and professional levels, and having visions to improve and guide quality improvement/change. Developing leaders should begin at the pre-registration phase, in line with GDC guidance ‘Preparing for Practice’, expecting leadership training to be provided, including education in human factors, systems thinking, conflict resolution, reflective practice, inclusion, ethical decision-making, and hybrid exposure to leadership theory and real-world leadership practices. 19,22 There is, however, insufficient evidence to support any one approach or theory to developing effective leaders in dentistry, suggesting that intuitive and combined models are needed to improve leadership within the profession. 23 Recognition of the need to improve and integrate leadership training into the dental curriculum has been advocated many years, with Health Education England providing such recommendations after a review of education and training within the profession in 2017. 24 Health Education England reported also that developing a leadership programme specific to dentists would be an excellent l opportunity to address the current shortfalls in leadership. A survey examining the perceptions of dental professionals on the GDC register regarding leadership development showed that more than 60% of respondents believed leadership training was equally important as job-related training. 25 Perceptions of effective leaders, including qualities such as honesty, integrity, communicators and inspirational, conform to effective leadership theories such as transformational leadership. 25,26 A third of respondents reported involvement in leadership training, or organisations offering leadership programmes. 25 Leadership programmes offered by institutions, such as the British Dental Association and the NHS Leadership Academy, have not been evaluated empirically by dentists, posing uncertainties over their impact on leadership development in the profession. Evaluation reports of these programmes, however, have indicated effectiveness in developing leadership skills consistent with contemporary models, as well as enhancing leadership confidence, necessary for translating skills into practice. 27 A study conducted in Greece showed that a leadership programme for undergraduates was effective in supporting development through enhancing skills related to prioritisation, time management, collaboration, setting goals/visions, emotional intelligence and decision making. 20 However, improving such skills and leadership potential among dental students has an uncertain translation into the leadership skills necessary to successfully lead a dental practice in the ‘real world’. At the general healthcare and wellbeing level , a recent umbrella review of leadership training showed positive effects on developing effective leaders with improved interpersonal skills, self-awareness, theoretical-congruence, emotional intelligence, teamworking and communication. 28 However, the reviews informing the umbrella review lacked evidence pertaining to dentists, highlighting further impediments to deriving robust recommendations for developing leadership in the dental profession. Overcoming barriers to leadership development appears central to supporting greater uptake and successful completion of formal leadership programmes, with the commonly reported barriers including lack of awareness of relevant programmes, lack of time/capacity to attend leadership training, cost and, regrettably, perceptions of leadership being irrelevant to roles and responsibilities in dentistry. 25 Tackling these barriers in the finitely funded and resource - pressured NHS may prove difficult; however, ongoing reforms may improve the capacity to provide protected time to support professional development in the healthcare workforce. 29 In interviews with dental leaders, developing leadership skills was noted to arise in dental school, with role modelling of supervisors and professors being perceived as an effective exposure promoting leadership skill development. 2 While role modelling has received empirical support in leadership skill development 30,31 , the study of Harnagea et al. 2 , based on a small and poorly generalisable sample of 11 dental experts, provides little evidential support for such thinking. A recent study by Jornet and Kalenderian 32 explored the impact of a, three-day course to enhance leadership in dentists. Twenty-two practising dentists were surveyed before, and 6-months following the educational course. The findings indicated that there were significant improvements in leadership knowledge (p<0.001). In addition, there was a significant improvement in leadership competencies based on a self-assessment, suggesting that development programmes are valuable for both dental professionals and students. 32 The study was, however, limited by a small sample size and risks of selection bias and type II error due to potentially underpowered statistical analyses. Experiences of leadership development activities in the post-registration period have been reported as significantly more influential on skill development and leadership confidence, suggesting that programmes may not be required prior to professional registration. 10 Despite this, almost all dental students have been found to value and seek leadership training during their time at dental school, to enhance their readiness for the transition to independent practice. 33 Finally, a novel theory of dental leadership has been described but remains under-investigated empirically. 34 The Leader-Member Exchange theory (Figure 2) posits that the effective leadership of clinical teams relies on the quality of relationships between members, as opposed to the specific style of leadership utilised when delivering and coordinating care. While Leader-Member Exchange theory has been associated with trust, respect, support and open communication within various disciplines, it has yet to undergo evaluation in dentistry (34). The empirical support for this theory in other disciplines does, however, support its value for the potential integration into dental leadership development programmes. 35,36 Behavioural theories of leadership have been used extensively to support leadership education in the healthcare professions, generally favouring democratic and empowering styles, and disfavouring authoritarian approaches. 20 Democratic leaders focus on cooperating with team members, seeking feedback, opinions and inputs, enabling inclusion and participation of followers in decision making. This can help to foster a sense of belonging and promote job satisfaction through emphasising role purpose. 37 However, a hybrid model of leadership using democratic and authoritarian styles has some residual importance as dentists may need to utilise directive and assertive approaches, such as during emergencies. 37 Such hybrid models may also benefit from adopting other traits of effective leaders, such as empowerment, which has been central to motivating teams, boosting resilience and supporting team efforts in the presence of extreme service and system pressures. 38 An example of a model proposed for use in dental leadership development is shown in Figure 3. Conclusion This scoping review has explored the importance and value of leadership in dentistry, the current issues in developing effective leaders in the profession and the means to improving leadership development in the future. The content highlights the importance of leadership as a key determinant of quality of care, patient safety, staff wellbeing and the longevity of service provision. Leadership is, therefore, of great importance to the future of UK dentistry, specifically in NHS funded dentistry, where funding and resources are limited, incurring significant pressures at the practice level and restricting the number of opportunities and capacity of services to support protected time for professional development. Despite the importance of effective leadership, research evaluating the impact of specific leadership approaches and strategies for leadership development within the dental profession is scarce. This is despite professional bodies and regulatory and national policies advocating the role of leadership as essential for maintaining the dental workforce and its competence for meeting population needs. The current review revealed that traditional and authoritative/managerial models of leadership remain in widespread use in dental practice and are therefore obstructive to developing leaders with more inclusive, participative and relational styles, which have been linked to favourable outcomes in other aspects of healthcare. Educational interventions at both the student and post-registration levels appear important for transforming leadership within the profession and developing leadership to better address real-world challenges. Such programmes have been linked to increased leadership knowledge, skills of effective leaders and confidence, but evaluations have been subject to methodological flaws, limiting overall credibility. Emerging theories, such as Leader-Member Exchange, may offer a foundation for revising and developing dental-specific leadership development programmes, harnessing the benefits of supportive and empowering relations between leaders and followers. In response to a paucity of evidence, it is strongly recommended that future research seek to evaluate novel leadership programmes across various contexts and settings, aiming to derive standardised and effective strategies for developing dental leaders of the future. Declarations Ethics declaration The authors declare no conflicts of interest. This scoping review was exempt from ethical approval as it involved only the synthesis and analysis of publicly available, peer-reviewed literature. No primary data collection was conducted, and the study did not involve human subjects, surveys, or experiments. Author contributions IRB and CDL conceptualised the review and led the writing of the original draft. IRB, CDL and NHFW contributed to the literature search and assisted in synthesizing the sources, drafting and editing the manuscript. IRB and CDL provided critical revisions. All authors read and approved the final manuscript. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8823910","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":590108187,"identity":"d2b1e261-17e3-4ab3-9a50-9128631f6dec","order_by":0,"name":"Igor Blum","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACNhDB2GDBwMDewEaSFgkGBp4DEC08ROkDa5FIIFILH//iYx8Yd0gkrp359tjDHwx35OwJOkziWfIMxjMSidtu56Ub8zA8MyZoC5vEGWMGxjaQlhwzaQaGw4k9xGu5ecZM8gfD4XrCWvh7oFpu8JhJ8DAcTiDCYWzJDIlnJIy3nQE6jMfgsGHPAQJa5PsPH2b4uMNGdttxkMMqDsuzNxCyRiKBgSEBzjMgpBwE+Am5YxSMglEwCkYBAHZtOYaRwMBhAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-6151-6516","institution":"King's College Hospital","correspondingAuthor":true,"prefix":"","firstName":"Igor","middleName":"","lastName":"Blum","suffix":""},{"id":590108188,"identity":"820f399c-c4bc-4886-a96d-2871619c5072","order_by":1,"name":"Christopher D. 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and value of leadership within the healthcare professions is continuing to gain importance, given research to support associations between leadership and enhanced quality of care and patient safety.\u003csup\u003e1\u003c/sup\u003e Within dentistry, however, the role and value of leadership remains less well understood, posing uncertainty over education and training programmes designed to develop the next generation of dental leaders.\u003csup\u003e2 \u003c/sup\u003eThis is despite the General Dental Council (GDC) emphasising the importance of leadership for various responsibilities within its standards of practice, including: prioritising and maintaining patient safety, upholding infection prevention and control, evidence-based practice, promoting effective teamworking, and assessing staff performance in relation to ethical principles, professionalism and scopes of practice.\u003csup\u003e3\u003c/sup\u003e \u003c/p\u003e\n\n\u003cp\u003eNational policies in the United Kingdom (UK), such as the National Health Service (NHS) Long Term Plan, seek to reform the health system and its various services, including dentistry through enhancing integrated care.\u003csup\u003e4\u003c/sup\u003e Should stakeholders fail to provide appropriate leadership, there is a risk that dentistry and the dental profession will be excluded from policy reforms, potentially resulting in adverse future challenges, ranging from deteriorating population dental and oral health, increasing difficulties in accessing dental services\u003csup\u003e5\u003c/sup\u003e and dentally related aggravation of chronic non-communicable diseases, such as diabetes. The dental profession is expected to adopt multi-disciplinary models of care, integrating state-of-the-art expertise in various disciplines to address patients\u0026rsquo; varied needs. This requires effective leadership, specifically in the effective delivery of complex care.\u003csup\u003e6\u003c/sup\u003e Such leadership, in contrast to leadership at the national or health system level, requires leadership skills at the community and individual service levels.\u003csup\u003e5\u003c/sup\u003e \u003c/p\u003e\n\n\u003cp\u003eThere is evidence to suggest that leadership is lacking within the dental profession. In an opinion paper, Nalliah\u003csup\u003e7\u003c/sup\u003e highlights that the majority of dentists work in isolation or within small teams and, as a consequence, tend to acquire management as opposed to leadership skills. This is reflected in observations that dentists largely use authoritative, directive and assertive styles to delegate tasks and manage service provision. As a result, dentists face significant challenges in becoming effective leaders, as the skills they develop through experience tend to be in conflict with those required of effective leaders.\u003csup\u003e7\u003c/sup\u003e In addition, the many dentists attracted to the profession by the autonomy of practice a lack the traits and external influences associated with effective leadership.\u003csup\u003e8\u003c/sup\u003e Such problems have been identified in the United States, where a survey of dentists showed that leadership is valued but lacking in practice, in part, given barriers such as time constraints, lack of leadership education, and a paucity of leadership training programmes.\u003csup\u003e9\u003c/sup\u003e This survey showed also that engagement in leadership activities was suboptimal by 40% of the 593 dentists who participated (9). In another survey, Taichman \u003cem\u003eet al.\u003c/em\u003e\u003csup\u003e 10\u003c/sup\u003e reported that up to two-thirds of dentists felt that poor readiness for leadership in practice was the result of omissions in education and training at the undergraduate level, and \u0026lt;70% indicated that post-registration experience was an important driver to engage in leadership.\u003c/p\u003e\n\n\u003cp\u003eIn the UK, a similar picture has emerged with a mixed methods study showing that leadership among dentists is variable and often founded on hierarchical, non-collaborative and individually-centric styles, linked to frustration among members of dental teams, specifically a lack of involvement in decision making.\u003csup\u003e11\u003c/sup\u003e Staff also perceived leadership hierarchies as barriers to the translation of guidelines and a deterrent to maintaining evidence-based practice.\u003csup\u003e11\u003c/sup\u003e Also, failures and challenges in developing effective leaders in dentistry have been noted within the academic field, where women seeking leadership positions encountered obstructions related to insufficient mentoring, training and sponsorship.\u003csup\u003e12\u003c/sup\u003e Thus, there is an apparent lack of inclusion and representation of effective leadership across dental hierarchies, contributing to ineffective leadership at the practice level. Developing effective leaders in dentistry is pivotal to supporting patient safety and continuous quality improvement processes. This is based on empirical evidence demonstrating associations between leadership dimensions and measures of patient safety, care quality and staff wellbeing.\u003csup\u003e13,14\u003c/sup\u003e In addition, evidence noting such associations within healthcare may also harbour applicability to the dental profession, given shared nuances of practice and factors influencing patient outcomes.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\n\u003cp\u003eGiven the leadership imperative in dentistry, there is a need to understand the ways in which the profession can support the development of effective leaders to sustain and, where possible, improve quality of care and clinical outcomes in the future. This rapid scoping review aimed to address this issue by evaluating the pre-existing literature. The objectives of this review were to identify the effective means of developing effective leaders and to formulate recommendations for ongoing leadership development practices, related policies and future research. \u003c/p\u003e\n"},{"header":"Methods","content":"\u003cp\u003eScoping reviews are credited for providing rapid insights into novel construct areas through enabling the evaluation of numerous and broad evidence sources.\u003csup\u003e15\u003c/sup\u003e Considering data and opinions from differing sources is often needed in situations where primary empirical evidence may be lacking and/or methodologically challenging to conduct, consistent with the topic of interest. The search for literature sources was conducted using a range of information mediums, including core electronic databases including, MEDLINE, EMBASE and AMED, and Google Scholar.\u003csup\u003e16\u003c/sup\u003e A broad search was conducted to help capture all key sources of information, helping to generate a rigorous insight into the strategies for developing effective clinical leaders. The search terms were based on key phrases including \u0026lsquo;healthcare\u0026rsquo;, \u0026lsquo;dentistry\u0026rsquo;, \u0026lsquo;dental\u0026rsquo;, \u0026lsquo;leadership\u0026rsquo;, \u0026lsquo;leaders\u0026rsquo;, \u0026lsquo;effective\u0026rsquo;, \u0026lsquo;development\u0026rsquo;, \u0026lsquo;education\u0026rsquo;, \u0026lsquo;training\u0026rsquo;, and \u0026lsquo;program\u0026rsquo;. The captured records were screened for relevance, and those contributing value towards the review aim were included in the following narrative synthesis. The process of narrative synthesis was suited to evaluating the findings due to the inclusion of varied sources and the related excess heterogeneity that emerged.\u003csup\u003e17\u003c/sup\u003e\u0026nbsp; The synthesis was interspersed with a critical appraisal of the literature, seeking to promote objectivity in reporting.\u003csup\u003e18\u003c/sup\u003e In addition, a discussion of wider related literature has been included to generate broader relevance and validation of the positive and less positive findings.\u003csup\u003e17\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003eIn an account provided by Blum\u003csup\u003e19\u003c/sup\u003e, leadership in dentistry is described as being at a significant crossroads; this is illustrated in Figure 1. Dentists are required not only to manage teams, but also to exercise leadership to sustain high-quality care in the context of increasing complexity and systemic pressures, while navigating ethical and regulatory demands, diverse patient needs, and emerging digital technologies. It has therefore been argued that, without the development of more effective leadership capability, the dental profession may be unable to meet the needs of future populations. Blum\u003csup\u003e19\u003c/sup\u003e initially suggests that challenging pre-existing assumptions and narrow lenses of leadership is a key first step. Conventionally, leaders in dentistry have naturally emerged as a result of extensive practice experience and adopting the most senior statuses within practices, mitigating opportunities for others who may have traits and skills conducive to effective leadership theories and styles; those that lack authoritative or overly assertive approaches.\u003csup\u003e 19,20\u003c/sup\u003e \u003c/p\u003e\n\n\u003cp\u003eBlum\u003csup\u003e19\u003c/sup\u003e states that effective leadership demands less focus on hierarchy and greater attention in fostering inclusive and supportive relations and cultures, conforming to transformational and participative styles of leadership, which have been extensively investigated in healthcare and have been associated with favourable outcomes.\u003csup\u003e21\u003c/sup\u003e As a consequence, Blum\u003csup\u003e19\u003c/sup\u003e argues that developing future dental leaders demands several strategies: reflective practice, effective communication skills, emotional intelligence, supportive and empowering staff on personal and professional levels, and having visions to improve and guide quality improvement/change. Developing leaders should begin at the pre-registration phase, in line with GDC guidance \u0026lsquo;Preparing for Practice\u0026rsquo;, expecting leadership training to be provided, including education in human factors, systems thinking, conflict resolution, reflective practice, inclusion, ethical decision-making, and hybrid exposure to leadership theory and real-world leadership practices.\u003csup\u003e19,22\u003c/sup\u003e There is, however, insufficient evidence to support any one approach or theory to developing effective leaders in dentistry, suggesting that intuitive and combined models are needed to improve leadership within the profession.\u003csup\u003e23\u003c/sup\u003e \u003c/p\u003e\n\n\u003cp\u003eRecognition of the need to improve and integrate leadership training into the dental curriculum has been advocated many years, with Health Education England providing such recommendations after a review of education and training within the profession in 2017.\u003csup\u003e24\u003c/sup\u003e Health Education England reported also that developing a leadership programme specific to dentists would be an excellent l opportunity to address the current shortfalls in leadership. A survey examining the perceptions of dental professionals on the GDC register regarding leadership development showed that more than 60% of respondents believed leadership training was equally important as job-related training.\u003csup\u003e25\u003c/sup\u003e Perceptions of effective leaders, including qualities such as honesty, integrity, communicators and inspirational, conform to effective leadership theories such as transformational leadership.\u003csup\u003e25,26\u003c/sup\u003e A third of respondents reported involvement in leadership training, or organisations offering leadership programmes.\u003csup\u003e25\u003c/sup\u003e \u003c/p\u003e\n\n\u003cp\u003eLeadership programmes offered by institutions, such as the British Dental Association and the NHS Leadership Academy, have not been evaluated empirically by dentists, posing uncertainties over their impact on leadership development in the profession. Evaluation reports of these programmes, however, have indicated effectiveness in developing leadership skills consistent with contemporary models, as well as enhancing leadership confidence, necessary for translating skills into practice.\u003csup\u003e 27\u003c/sup\u003e A study conducted in Greece showed that a leadership programme for undergraduates was effective in supporting development through enhancing skills related to prioritisation, time management, collaboration, setting goals/visions, emotional intelligence and decision making.\u003csup\u003e20\u003c/sup\u003e However, improving such skills and leadership potential among dental students has an uncertain translation into the leadership skills necessary to successfully lead a dental practice in the \u0026lsquo;real world\u0026rsquo;. \u003c/p\u003e\n\n\u003cp\u003eAt the general healthcare and wellbeing level , a recent umbrella review of leadership training showed positive effects on developing effective leaders with improved interpersonal skills, self-awareness, theoretical-congruence, emotional intelligence, teamworking and communication.\u003csup\u003e28\u003c/sup\u003e However, the reviews informing the umbrella review lacked evidence pertaining to dentists, highlighting further impediments to deriving robust recommendations for developing leadership in the dental profession. Overcoming barriers to leadership development appears central to supporting greater uptake and successful completion of formal leadership programmes, with the commonly reported barriers including lack of awareness of relevant programmes, lack of time/capacity to attend leadership training, cost and, regrettably, perceptions of leadership being irrelevant to roles and responsibilities in dentistry.\u003csup\u003e25\u003c/sup\u003e Tackling these barriers in the finitely funded and resource - pressured NHS may prove difficult; however, ongoing reforms may improve the capacity to provide protected time to support professional development in the healthcare workforce.\u003csup\u003e29\u003c/sup\u003e In interviews with dental leaders, developing leadership skills was noted to arise in dental school, with role modelling of supervisors and professors being perceived as an effective exposure promoting leadership skill development.\u003csup\u003e2\u003c/sup\u003e While role modelling has received empirical support in leadership skill development\u003csup\u003e30,31\u003c/sup\u003e, the study of Harnagea \u003cem\u003eet al.\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e, based on a small and poorly generalisable sample of 11 dental experts, provides little evidential support for such thinking. \u003c/p\u003e\n\n\u003cp\u003eA recent study by Jornet and Kalenderian\u003csup\u003e32\u003c/sup\u003e explored the impact of a, three-day course to enhance leadership in dentists. Twenty-two practising dentists were surveyed before, and 6-months following the educational course. The findings indicated that there were significant improvements in leadership knowledge (p\u0026lt;0.001). In addition, there was a significant improvement in leadership competencies based on a self-assessment, suggesting that development programmes are valuable for both dental professionals and students.\u003csup\u003e32 \u003c/sup\u003eThe study was, however, limited by a small sample size and risks of selection bias and type II error due to potentially underpowered statistical analyses. Experiences of leadership development activities in the post-registration period have been reported as significantly more influential on skill development and leadership confidence, suggesting that programmes may not be required prior to professional registration.\u003csup\u003e10\u003c/sup\u003e Despite this, almost all dental students have been found to value and seek leadership training during their time at dental school, to enhance their readiness for the transition to independent practice.\u003csup\u003e33\u003c/sup\u003e \u003c/p\u003e\n\n\u003cp\u003eFinally, a novel theory of dental leadership has been described but remains under-investigated empirically.\u003csup\u003e34\u003c/sup\u003e The Leader-Member Exchange theory (Figure 2) posits that the effective leadership of clinical teams relies on the quality of relationships between members, as opposed to the specific style of leadership utilised when delivering and coordinating care. While Leader-Member Exchange theory has been associated with trust, respect, support and open communication within various disciplines, it has yet to undergo evaluation in dentistry (34). The empirical support for this theory in other disciplines does, however, support its value for the potential integration into dental leadership development programmes.\u003csup\u003e35,36\u003c/sup\u003e \u003c/p\u003e\n\u003cp\u003eBehavioural theories of leadership have been used extensively to support leadership education in the healthcare professions, generally favouring democratic and empowering styles, and disfavouring authoritarian approaches.\u003csup\u003e20\u003c/sup\u003e Democratic leaders focus on cooperating with team members, seeking feedback, opinions and inputs, enabling inclusion and participation of followers in decision making. This can help to foster a sense of belonging and promote job satisfaction through emphasising role purpose.\u003csup\u003e37\u003c/sup\u003e However, a hybrid model of leadership using democratic and authoritarian styles has some residual importance as dentists may need to utilise directive and assertive approaches, such as during emergencies.\u003csup\u003e37\u003c/sup\u003e Such hybrid models may also benefit from adopting other traits of effective leaders, such as empowerment, which has been central to motivating teams, boosting resilience and supporting team efforts in the presence of extreme service and system pressures.\u003csup\u003e38\u003c/sup\u003e An example of a model proposed for use in dental leadership development is shown in Figure 3.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review has explored the importance and value of leadership in dentistry, the current issues in developing effective leaders in the profession and the means to improving leadership development in the future. The content highlights the importance of leadership as a key determinant of quality of care, patient safety, staff wellbeing and the longevity of service provision. Leadership is, therefore, of great importance to the future of UK dentistry, specifically in NHS funded dentistry, where funding and resources are limited, incurring significant pressures at the practice level and restricting the number of opportunities and capacity of services to support protected time for professional development. Despite the importance of effective leadership, research evaluating the impact of specific leadership approaches and strategies for leadership development within the dental profession is scarce. This is despite professional bodies and regulatory and national policies advocating the role of leadership as essential for maintaining the dental workforce and its competence for meeting population needs. The current review revealed that traditional and authoritative/managerial models of leadership remain in widespread use in dental practice and are therefore obstructive to developing leaders with more inclusive, participative and relational styles, which have been linked to favourable outcomes in other aspects of healthcare. Educational interventions at both the student and post-registration levels appear important for transforming leadership within the profession and developing leadership to better address real-world challenges. Such programmes have been linked to increased leadership knowledge, skills of effective leaders and confidence, but evaluations have been subject to methodological flaws, limiting overall credibility. Emerging theories, such as Leader-Member Exchange, may offer a foundation for revising and developing dental-specific leadership development programmes, harnessing the benefits of supportive and empowering relations between leaders and followers. In response to a paucity of evidence, it is strongly recommended that future research seek to evaluate novel leadership programmes across various contexts and settings, aiming to derive standardised and effective strategies for developing dental leaders of the future. \u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest. This scoping review was exempt from ethical approval as it involved only the synthesis and analysis of publicly available, peer-reviewed literature. No primary data collection was conducted, and the study did not involve human subjects, surveys, or experiments.\u003c/p\u003e\n\n\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIRB and CDL conceptualised the review and led the writing of the original draft. IRB, CDL and NHFW contributed to the literature search and assisted in synthesizing the sources, drafting and editing the manuscript. IRB and CDL provided critical revisions. All authors read and approved the final manuscript.\u003c/p\u003e\n\n\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting this scoping review are available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMurray M, Cope V. Leadership: Patient safety depends on it! Collegian. 2021;28(6):604-9.\u003c/li\u003e\n\u003cli\u003eHarnagea H, Bedos C, Kabir R, Dawson A, Power F, Brown-Johnson A, et al. Voicing Beliefs on Global Leadership for Dentistry. International Dental Journal. 2022;72(4):529-35.\u003c/li\u003e\n\u003cli\u003eGDC. 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J Healthc Leadersh. 2024;16(1):443-54.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"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-8823910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8823910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: With ongoing uncertainty about how dental leadership should evolve to meet future real-world challenges, this rapid scoping review evaluated existing literature to identify strategies that most effectively develop leadership skills in dentistry.\u003c/p\u003e\n\u003cp\u003eMethods: Multiple sources (MEDLINE, AMED, EMBASE and Google Scholar) were searched using terms relating to ‘healthcare’, ‘dentistry’, ‘leadership’, ‘effectiveness’, ‘development’, ‘education’, ‘training’ and ‘programmes’. Records were screened for relevance; eligible sources informing the aim were included. Findings were interpreted and reported using narrative synthesis principles.\u003c/p\u003e\n\u003cp\u003eResults: Evidence was diverse but centred on leadership development. Dentistry is often described as relying on hierarchical, authoritative and managerial approaches, which may limit the development of future leaders. Education and training at pre- and post-registration levels were consistently highlighted as ways to transition toward leadership models shown to work elsewhere in healthcare, including transformational and participative leadership. These styles may enhance quality of care and patient safety, optimise staff wellbeing, and sustain workforce capacity and competence.\u003c/p\u003e\n\u003cp\u003eConclusions: Leadership is fundamental to care quality, patient safety and workforce resilience. Despite strong regulatory, professional and policy emphasis, evidence remains limited regarding which leadership styles and development methods are most effective in dentistry. Future research should address these gaps by evaluating theory-informed dental leadership development programmes and their impacts.\u003c/p\u003e","manuscriptTitle":"Preparing the next generation of dental leaders: a scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 05:47:08","doi":"10.21203/rs.3.rs-8823910/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-04-17T12:18:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-16T15:36:59+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-04-02T10:16:25+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-02-13T10:23:43+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-02-12T11:31:23+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2026-02-12T08:16:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-10T16:25:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-10T16:24:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"British Dental Journal","date":"2026-02-09T23:21:32+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2026-02-09T16:19:20+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":"a14f991f-b877-4c7e-a25f-02a004b93309","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":62790374,"name":"Health sciences/Health care/Dentistry/Dental education/Dental post graduate education"}],"tags":[],"updatedAt":"2026-04-17T12:21:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 05:47:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8823910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8823910","identity":"rs-8823910","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}