Sally Hanks is passionate about teaching and learning. After a number of years in general practice, and then in special care dentistry, she took a part-time lecturing role at Bristol Dental School and discovered a love of dental education, and the feeling that she could make a difference to the lives and education of her students. She then moved to the Peninsula School of Dentistry at Plymouth University, where the focus on real-life, practice-based dentistry was very attractive: “The students get to see a patient from start to finish. The patients walk in as they would in real life into your practice. I really like that because that’s what my career for the 20 years previous to this role had been”.
Sally is now Head of Teaching and Learning at Peninsula, and Module Lead for Professionalism for both the BDS and the BSc in Dental Therapy and Hygiene. With approximately 90 students in each year group, Sally’s is a busy role, and she sees dental education as a holistic process that’s about far more than just teaching students to care for teeth: “Our job is to make the next generation of dentists better than we are, and to be always looking to improve the profession, not just each individual. It’s also to support each of those students to be the very best they can be. I see education as a facilitator to supporting each individual on their own journey, to empower them to be able to make their own decisions and to be comfortable in that”. She’s very aware that academic achievement is only part of the process: “You have to have a minimum level of knowledge to do the job, but it’s not all about that. If you got 100% in all of the assessments, but you couldn’t reason, think critically, and apply what you know to new and evolving situations, then you wouldn’t be able to treatment plan and problem solve – you wouldn’t be able to look after patients”.
One of the ways in which Peninsula has supported this integration of skills is with a dentistry humanities module in the final year, where students have the opportunity to work with actors, musicians, creative writers and artists. Sally says the results have been extraordinary: “We had some generic learning objectives from these sessions, such as: ‘What have you learnt about yourself, or about interacting with other people?’ What came back was the students learnt so much else outside that. They learnt a lot about resilience building, stress relief and stress management. Many of them carried on doing the subjects that they started, such as life drawing or creative writing or music. They found it really helped them to learn about themselves and about how to cope”.
Sally is also responsible for the student and patient feedback processes at Peninsula, and it’s something she sees as vital to the learning process, for students, patients and staff: “I know some of the things that students need to know when they come out at the end of their dental training. I know what it’s like to be a dentist, and how to marry these things and create a really good education programme for students. But I don’t know how it feels for students, and I don’t know what that feels like for a patient”.
The School uses a range of feedback strategies, from anonymous questionnaires and focus groups, to individual and direct feedback from patient to student, and from student to teacher: “We support the students in receiving that feedback and we support the patients in giving it. The ethos for the patients is we want our students to be great, not just good, and you can help us to do that by telling them little things that might make a difference. It’s not about saying they’re not doing well, it’s about us saying: ‘Your patient thinks that that could change, and that might help them even more’. For our student feedback it is very much that we need to listen and hear what’s been received, regardless of what our intention was. Students can be very critical, and it’s great that they can, but it’d be really good if they could learn to be critical in a constructive way. That’s what we’re trying to do with these strategies for patients and students: everybody should be able to give feedback in a way that’s useful”.
Of course, the Covid-19 pandemic has meant radical changes to the way that Sally and her team do their jobs, and some of these changes will be at least semi-permanent, but Sally is extremely proud of how her team has handled the crisis: “My team has gone to extraordinary lengths to make sure that not only teaching and learning and the information is there for the students, but that you can still come and talk to us. It’s an open Zoom policy rather than an open door policy!”
There have been positives too: “It’s amazing the ideas that people come up with; being somewhere completely unfamiliar means you can think in a completely different way. It actually can be quite freeing: terrifying, but also freeing! We’re doing things that we never thought we’d have to do, and we’ve found that sometimes they’re just as good as, or have advantages over, what we’ve done before”.
This is feeding into their plans for an eventual return to on-site work: “We can’t turn dentistry into a distance learning course, nor will we try. Obviously, we have to work within Government and national guidelines, but we have been planning a strategy for how to support our students to get back to patient care safely. Our ultimate goal will be to make sure that the students get the experience and the training they need to enable them to get out and be really good dentists”.
While clinical practice is now only a small portion of Sally’s work, her interest in it, and in what can make it better for those who are in general practice, has never waned, and led her to undertake a PhD in management and leadership in general dental practice. When an update to the General Dental Council learning outcomes was released, including a section on management and leadership, Sally found it difficult to find material to help educate her students in those outcomes: “I realised that for the dentist in dental practice, the real-life coal face of dentistry, management and leadership was something that hadn’t been very clearly defined. So my whole ethos was, well, can I go and see it for myself? Can we see how leadership works in a dental practice? Will it be something we can see, and if it is, how can I then make it useful for supporting ongoing education?”
Sally opted for a methodology called video reflexive ethnography, which involved going out into dental practices and videoing dentists at their work: “The reflexive element is that after that, I watched the videos back with those dentists. That was key: it’s not just being observed and someone else putting a meaning on that, it’s working together to create new knowledge”. What she found was that leadership in dentistry is not just one thing, but is rather a complex and dynamic pattern of behaviours and processes: “It’s not as straightforward as: if you’re that kind of person, or if you do that, then that’s great leadership. It’s about relationships, emotional intelligence, self-awareness and awareness of others. In a practice, it’s about the community of practice that you’re working in”.
Sally used this information to develop a conceptual model for leadership, comprised of six elements: three external (see page 111) and three internal. While the external elements range from the regulatory and legislative structures a dentist has to engage with, to their role as practice owner and employer, the internal elements cut to the heart of each practitioner’s identity: “The three things that were internal to the dentist were their personal and professional identity, their capability and flexibility, and their relationships. By that I mean capability and flexibility in their thinking processes, in their emotional and mental processing, the ability to be agile in thinking, and in feeling”. For general dentists who may not be used to thinking of what they do as a constant balancing of these personal and professional selves, or who may feel the need to separate the personal from the professional in order to be a ‘good’ dentist, Sally’s research shows that this is not necessary, nor is it really possible, or indeed desirable: “It’s very easy to overlook the importance of who we are as individuals. We all bring something to each of the interactions that we have, whether that’s with one person or with many people. That’s what was really interesting in the findings of this PhD – that it is really important who the dentist is. Their identity, personal and professional, impacts on their leadership activities. That can be both frightening and reassuring. For those of us who prefer to be able to do a job without being part of it, then it’s terrifying because you’re in it whether you want to be or not. For those who want it all to be about who they are, there’s the realisation that it’s about other people as well”.
Sally uses an anecdote from her PhD to explain: “One of the dentists was faced with a child with wall-to-wall tooth decay. As an individual they felt really angry with the situation, with the parents who had let that child get into that much pain. They felt really upset for that child. As a clinician they were looking at that as: ‘I’ve got to do something to help, and how am I going to use my professional skills to do this?’ As a business person, they were thinking ‘I’m not getting paid for this because we don’t get paid to treat children’. It is really important to recognise that individual emotional response in the professional environment, and say: ‘Okay, I am acting with my professional hat on, but I recognise that I am depressing this emotional response, which is also me’”.
The new normal
This has, of course, particular relevance at the moment, as dentists adapt to an entirely new world of practice in the wake of restrictions on how they can see and treat patients. It seems that in this new post Covid-19 world, it will be more important than ever to embrace the different aspects of our identities, whether in dentistry or any profession, and apply that awareness to make things better. Sally hopes her research will be helpful in this process: “Leadership levels on their own can be helpful to increase self-awareness, understanding that we will be impacted as an individual, and as a clinician, and as a business person. Our professional and our personal identity will be impacted, and our community of practice will be impacted because our communities are changing. Sometimes just being able to think, ok, that’s impacted me on an individual level, and I know therefore it’s going to have a reciprocal influence on all those other areas, just might help. This model has helped me and hopefully will help others”.