The 4 P's model of creativity has been the most widely adopted creativity framework since the 1960's (12), enabling researchers a structure to scaffold thinking and experimentation concerning creativity. In this model, the creative product is built by the creative person as the result of the creative process, while being supported in a creative environment (Press). Despite its widespread adoption, recent reflection on the model has questioned its individualistic vision of creativity. Given that dental education relies on interactive and context-dependent activities and prioritises the performative and relational aspects of the profession (including practitioner-patient interactions), we will take a more contextual and dynamic approach to considering creativity in tertiary education settings by adopting the 5 A's framework of creativity (13). This recent adaptation of the 4 P's model consists of five elements: actor, action, artifact, audience, and affordances.

A comparison of the two models shows similarities between each of the elements, although the focus of each differs slightly, with the relational or contextual aspect underscored in the 5 A's model (Figure 1). Comparing the models, the final element exhibits the greatest conceptual shift, with Press—referring to the “pressing” environmental influences that surround a creative person and their creative product—being divided into two separate categories in Glăveanu's 5A's model: Audience and Affordances. This division allows us to reflect more deeply on both the social and material environments that a creative dental educator (Actor) works with and in. Glăveanu's definition of the audience as “multiple others that assist, contribute, judge, criticise, or use the creative act and/or resulting artifact(s)” (p. 74) is an important distinction that aligns with the role of collaboration, for example through peer-review of teaching for dental educators (14). The Affordances of this model speaks to the environment in which educators work, and the role of leadership in fostering creativity in tertiary settings. Learning environments require three key elements to be implemented to ensure creativity is fostered at a tertiary level: designing creative learning environments, facilitating student creativity, and modelling creative pedagogical practice (15). This involves embedding creativity at the level of the learning environment, the student, and the teacher, complementing Beghetto's assertion that creative teaching must include “teaching about creativity, teaching for creativity, and teaching with creativity” (16) (p. 549). We will now discuss the relationship between creativity of individuals and innovation in institutions, giving examples from dental education and relating these examples to the elements of the 5A's model. In doing so, we seek to identify the elements of this framework that appear most relevant for dental education, providing clues as to where leadership can focus their support for creativity and therefore innovation.

Our expertise or knowledge is the foundation of our creativity, because new ideas are built on old ideas (21). However, the complexity of problems faced by organisations often necessitates expertise across multiple domains to generate new ideas (17). A useful framework for conceptualising the expertise required of dental educators is the Technological Pedagogical Content Knowledge (TAPCK) framework (22) which illustrates that content, pedagogy and technology must be integrated for effective teaching in the digital age (23).

As dental educators, we come to our roles often because of our content knowledge. However, the challenges facing dental educators may require knowledge across multiple content areas. In their recent discussion of the implications of healthcare challenges towards 2040 on dental education, Reddy and Hughes describe the need to integrate clinical, biomedical, population health and behavioural sciences in dental curricula (24), which requires content knowledge across multiple domains. Such integration of diverse content knowledge can be supported by developing teaching teams from multiple disciplines (25). This has particular relevance for developing interprofessional learning opportunities for oral health professional students. To complement content expertise, knowledge of how students learn is vital for dental educators. In a study of professional development in emerging pedagogies, collaborative development of pedagogical knowledge among dental educators was found to support the implementation of teaching innovation, with a lack of pedagogical knowledge acting as a barrier to adoption of innovative pedagogies (23). Mloka and colleagues reported a similar relationship between pedagogical knowledge and innovation even under challenging circumstances of increasing student numbers, high teaching loads and curriculum change (26). A lack of technological knowledge impedes innovation. Whilst dental educators have been employing a diverse range of technological tools in teaching for decades, barriers to the use of such tools in dental education include the need to understand new and complex technologies and how these can be incorporated into teaching practice (27) and a lack of familiarity with available tools (28). Educators need to understand how to utilise technologies to improve student learning. Employing an innovative self-study methodology, Leadbeatter and colleagues describe the collaborative development of technological knowledge that enabled them to understand technology as dental educators (29). Collectively, this indicates that to support the creativity of dental educators, institutions must encourage staff to work collaboratively to share and build their knowledge across relevant domains of content, pedagogy and technology. The implication for leadership is investment in dental educators as the creative Actor.

Whilst knowledge is vital for creativity, it can stifle innovation in the absence of creative thinking skills (30). Creative problem solving requires a combination of cognitive processes including problem definition, generation of new ideas, both divergent and convergent thinking (31), thinking broadly, and making unusual associations (18). Methods by which dental educators have demonstrated development of these creativity-relevant cognitive processes include design thinking, scenario planning and establishing professional learning communities. Design thinking is a problem-solving framework which encourages participants to work collaboratively with an open mind and suspension of judgement (32). Wolcott and colleagues recently employed a design thinking approach when leading dental faculty to the development of an innovative dental curriculum (33). Design thinking has also been suggested as an ideal approach for designing dental teaching clinics of the future (3). Scenario planning involves responding to hypothetical “what if” questions to create alternative futures (34). In a recent description of scenario planning in dental education, this method enabled educators to explore new ideas in relation to challenges in dental education including interprofessional collaborative practice, diversity and equity, access to dental care, and advocacy to enhance global oral health outcomes (34). Reviewing the proposed evaluation of scenario planning in dental education, Horvath and Quick describe that through engaging with this activity, educators can develop their creative thinking skills such as generating ideas for other contexts to address the challenges proposed by the scenario planning activity (35).

A professional learning community is a group of people who share and reflect on their practice with the view to grow and learn (36). Reflecting on how this definition relates to the 5A's model of creativity, each member of a professional learning community could be considered both as Actor and Audience. In a discussion of change management in dental education, Palatta proposes that participation in professional learning communities may enable creative thinking in dental educators (37). Whilst not explicitly identified as a professional learning community, the collaborative self-study approach of Leadbeatter and colleagues demonstrates characteristics of such a community. Exploring their approach (29), creativity-relevant processes are abundantly evident including considering new perspectives on problems and making unusual associations (17). An added benefit of a professional learning community may be a positive impact on the satisfaction and morale of dental educators (37). Therefore, returning to the 5A's model of creativity, design thinking, scenario planning, and the development of professional learning communities are collaborative Affordances which may enable the development of creativity-relevant attributes of dental educators who each play a dual role as Actor and Audience.

Motivation, particularly intrinsic motivation, is vital for creativity (38). Self-determination theory proposes that satisfying the three basic psychological needs for competence, autonomy and relatedness will enhance motivation (39). This suggests that educators need to believe they have the requisite knowledge and skills, have choice in how they enact their role, and a sense of belonging to a community with similar goals (38) in order to develop innovative solutions to the challenges facing dental education into the future. This aligns with the importance of developing pedagogical knowledge as illustrated by the TPACK framework discussed above. To see this in action, as we saw earlier, in a study of the impact of a professional development program to support the development of pedagogical knowledge, followed by formation of a learning community, dental educators reported they were motivated to improve their teaching practice, with reports of implementation of innovative teaching strategies (23). In a recent systematic review of the use of digital technologies in dental education, Zitzmann and colleagues assert that a high level of motivation is needed for educators to embrace an implement innovative digital technologies (40) and speculate that the digital infrastructure and the level of innovation of educators will be included in the raking of dental schools (40). Therefore, this combination of intrinsic and extrinsic motivation relates to both the Actor and Affordances of the 5A's model of creativity.

To this point, we have focused on factors that can enhance the creativity of individuals and teams of educators, and provided examples of how this can influence innovation in dental education. To support creativity and innovation we also need to look to contextual factors in organisations (7), which are conceptualised by Amabile and Pratt (2016) as motivation to innovate, relevant resources, and skills in innovation management (Figure 2) (17). These factors clearly align with Affordance in the 5A's model of creativity. Resources include financing for projects, infrastructure with the necessary materials and services, and enabling sufficient time to explore and implement creative solutions (17). For example, MacNeill and Hilario suggest that clinical placement operations that do not enable students from different health professions to interact and engage in integrated patient care is inhibiting interprofessional education (IPE) across dental schools in the US. They further suggest that dental schools need to explore external, community-based models of care to enable authentic interprofessional learning experiences (41). Such a solution requires resourcing in the form of time, financing and developing the appropriate model of care. A successful example of this can be found in a community-based IPE program that enabled nursing and dental students to engage in a collaborative care program, and successfully increased the oral health knowledge of program participants (42). Lack of various resources have been reported as barriers to implementing online learning in dental education. Over a decade has passed since Shonwetter and colleagues reported the greatest impediments to innovation in online learning in dentistry were institutional, including financial cost, technical support required, politics and a stakeholder resistance to change (27), highlighting the need for institutional support for innovation. Time or lack thereof is repeatedly reported as a barrier to implementing innovative pedagogies (28, 37, 43). Institutions must value the time it takes to develop and implement innovative approaches to dental education.