ABSTRACT
Introduction
Clinical leadership is essential for patient safety and effective healthcare delivery. While leadership training is increasingly integrated into medical education, there is no consensus on how to define, teach, or evaluate these skills. This scoping review aimed to map the existing literature on medical clinical leadership training and identify gaps.
Methods
Following PRISMA‐ScR guidelines, a comprehensive search was conducted across five major databases. Eligible studies were original studies involving any interventions with the purpose of improving leadership skills of participants, where most participants were doctors or medical students. Studies were screened and selected by multiple reviewers, and data were charted using a tool constructed for this study. Synthesis and thematic analysis were conducted with support from Datalab at the Library of Copenhagen University.
Results
Sixty‐two studies met the inclusion criteria. Out of these, 47 employed descriptive pre/post designs. Clinical leadership was defined explicitly by 15 studies, though a thematic analysis identified nine shared elements, including communication, emotional intelligence, and patient safety. Teaching methods varied, with simulations and lectures being most common. Out of 62 studies, 36 relied on self‐assessment for evaluation and satisfaction surveys, with limited long‐term or objective outcome measures. Evaluation methods of 56 studies fell within Kirkpatrick's levels 1 and 2, focusing on reaction and learning, rather than behavior‐ or long‐term changes.
Conclusion
Clinical leadership education is a growing but fragmented field. A clearer definition of clinical leadership, teaching methods, and evaluation tools are needed to improve future training programs and assess their effectiveness.
Editorial Comment
This scoping review summarizes the current literature regarding education on clinical leadership skills. More specifically the authors identified nine themes of clinical leadership by using a thematic analysis method, and also reported on different teaching and assessment methods. By assessing altogether 62 studies, concerning mainly doctors and medical students as learners, they identified a need for defining clinical leadership, and the teaching and evaluation methods more clearly.
1. Introduction
The quality of leadership in healthcare has been shown to significantly correlate with patient safety [1, 2], mortality [3, 4, 5] and improved healthcare outcomes [6, 7, 8]. Doctors, who are responsible for the overall care of the patient, often must interact and coordinate with several groups of personnel during routine procedures. This is especially true for doctors who have leading roles in multidisciplinary teams in high‐pressure environments, such as anesthesiologists, emergency specialists, and surgeons.
In response, there has been a growing focus on leadership education within the medical field. An example is the Royal College of Physicians & Surgeons of Canada including “leader” as one of the core competencies of a doctor in 2016 [9].
Despite team leadership being recognized as a trainable skill [10], and research showing that training improves leadership confidence [11], many young doctors still lack confidence in their leadership abilities [12, 13].
Recognizing this gap, efforts to provide leadership training for doctors and medical students have increased [14]. However, there is still no clear consensus on how to define clinical leadership [15], and the most effective ways to teach leadership to healthcare professionals remain uncertain. This lack poses a significant barrier to developing effective leadership education.
In this article, we have chosen to focus on education for leadership in clinical situations, as doctors have clinical leadership responsibilities from early in their career, and often only take on administrative tasks later. The definition of clinical refers to: “medical work or teaching that relates to the examination and treatment of ill people” [16]. Clinical leadership therefore refers to the doctor's role as leader in the clinical situation, as opposed to administrative leadership: “of or relating to administration or an administration: relating to the management of a company, school, or other organization” [17].
This scoping review aims to systematically map the existing body of research on leadership education for physicians and medical students. The goal is to provide an overview of current approaches, highlight areas of consensus and divergence, and identify gaps in the literature that warrant further research.
2. Methods
This scoping review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis, extensions for scoping reviews (PRISMA‐ScR) [18]. A protocol was developed and published in February 2025 [19].
2.1. Research Questions
Which types of evidence regarding clinical leadership education exist?
What aspects of successful clinical leadership does the literature identify?
How is clinical leadership taught and what are the pros and cons of these methods?
How is clinical leadership measured and what are the pros and cons of the methods in use?
How is leadership education currently structured?
2.2. Eligibility Criteria
We included articles describing interventions, primarily aimed at improving participants' clinical leadership skills. This included, but was not limited to, lectures, workshops, simulation training, and distribution of online or printed recommendations material. Participants groups must be comprised primarily of doctors and/or medical students. The emphasis had to be on clinical leadership, as opposed to administrative leadership or management.
All types of original studies were included, with no limitations to study design, language, geographical location, setting, source, or publication year. Opinion pieces, obituaries, viewpoints, review protocols, conceptual frameworks, conference abstracts, commentaries, conference proceedings, non‐health papers, and book reviews were excluded. Studies focused primarily on gender differences in leadership were excluded.
2.3. Information Sources and Search Strategy
The search strategy was created in collaboration with an experienced health science librarian. Searches were conducted in PubMed, Medline, Embase, Cochrane, and PsycINFO. Searches in Google Scholar were attempted and abandoned after consultancy with AM. The most recent search was completed on the December 17, 2024. Full searches can be found in Supplementary Appendix A.
2.4. Selection of Sources of Evidence
The search resulted in 19,219 articles. All citations were imported into Covidence [20] and 4014 duplicates were removed. Titles and abstracts were screened by two independent reviewers. NV screened all titles, and the second review was split between AN, CC, and NS. NV, AN, and CC read the full text of selected citations and assessed them in detail against the inclusion criteria. Most disagreements between the reviewers at each stage of the selection process were resolved by discussion between the reviewers. As disagreement could not be resolved regarding two articles, these were sent to AMM for final decision and were both included.
One paper, in German, was reviewed in full text by PD in the original language and by NV in translation, as PD is fluent in German and could offer valuable insight. The article was excluded.
In total 14,995 articles were excluded based on title and abstract, and 207 were assessed by full‐text screening. Sixty two studies were included for data charting. A Prisma diagram of the selection process can be found in Figure 1.
FIGURE 1.
Prisma.
2.5. Data Charting
The data charting‐tool was constructed by NV, who also carried out the data‐charting. Data items of interest were: the number of participants, their level of education, their specialty (if any), the type of intervention, how outcomes were measured, the study's definition of “good leadership,” results, and any reflections on the choice of intervention and evaluation methods.
Chat‐GPT [6] was used to shorten and format the charted information in the interest of keeping the charting document as concise as possible, in all categories, except “definition of good leadership,” “Feasibility of interventions,” and “Reflections on method of measure.” The AI was fed the text extracted from the articles and asked to shorten and format it. The result was read by NV and edited manually when necessary. The charted data was then sent for review to AN, CC, and NS, and their input and edits were implemented before the charted data was sent to PD and AMM for review and edits.
2.6. Data Synthesis
Different methods of data synthesis were used to answer different research questions. Data synthesis was conducted with assistance from KUB Datalab [21], who helped NV decide on how to best present the data and sparred about how to conduct the analysis. Especially for the question on what defined leadership, several options were tried, and ultimately, a thematic analysis was decided on.
The thematic analysis was conducted in accordance with Braun et al. [22], who outline the following steps: (1) familiarization with the data, (2) generation of initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes. The full analysis can be found in Supplementary Appendix B.
Note that only 15 papers explicitly defined aspects of clinical leadership. Therefore, initial codes were generated two ways: (1) from the articles explicitly defining what qualities a leader should possess or learn to fill their role or (2) from the evaluation method the studies used to assess participants as well as the main text of the articles.
3. Results
3.1. Results of Individual Sources of Evidence
Full list of articles included in the study, as well as all charted and analyzed data is available from the authors upon request.
3.2. Which Types of Evidence Regarding Clinical Leadership Education Exist?
Out of 62 studies, 47 studies used a descriptive pre/post intervention design, seven conducted RCTs, and two studies used a quantitative design. Additionally, six studies used other study designs.
Geographically, the studies were conducted in North America (38), Europe (16), Asia (3), Middle East (2), Africa (1), Oceania (1), and multinational (1).
The number of publications has increased over the years, with one article published 1 before 2000 and rising steadily to 23 articles published in 2024 alone.
3.3. What Aspects of Successful Clinical Leadership Does the Literature Identify?
Nine themes were identified through a thematic analysis and can be found in Figure 2, and ranged from concrete factors, such as leading from a global perspective, to the less measurable, like being committed to the growth of the team. The full thematic analysis can be found in Supplementary Appendix B.
FIGURE 2.
Nine themes of clinical leadership identified through thematic analysis of the included articles.
3.4. How is Clinical Leadership Taught and What are the Pros and Cons of These Methods?
Figure 3 provides an overview of the types of interventions described in the papers reviewed. Note that most studies used a mix of interventions.
FIGURE 3.
Types of interventions.
3.5. How is Clinical Leadership Measured and What are the Pros and Cons of the Methods in Use?
The method of measuring results used in the studies can be seen in Figure 4. The methods of evaluation were highly variable, but many studies relied on self‐assessment or a survey measuring the participants' satisfaction with the course.
FIGURE 4.
Methods of evaluation.
In order to further classify the methods used for evaluation, the studies were classified according to Kirkpatrick's levels [23]. Nine studies stated their own Kirkpatrick's levels. In the remaining studies, the Kirkpatrick's level of the evaluation was assessed by NV. Description of the levels can be found in Figure 5 and the Kirkpatrick's levels of the studies can be found in Figure 6.
FIGURE 5.
Description of Kirkpatrick levels.
FIGURE 6.
Distribution of Kirkpatrick levels across the studies.
All studies, except one [24], reported primarily positive results from the training.
3.6. How is Leadership Education Currently Structured?
The participants' level of education outlines in Figure 7. For studies where participants were at multiple levels of education, the highest level was counted.
FIGURE 7.
Level of education.
Courses offered to doctors during or after specialization were offered in a variety of different specializations, as can be seen in Figure 8.
FIGURE 8.
Specialty (if any) of course aimed at post‐graduate participants.
The durations of the courses ranged from a single hour to yearlong program integrated into medical education. The lack of consistent data on this matter makes it difficult to assess how much time is allocated to each program. However, 38 of the courses required less than an average workweek (37 h) of the participant's time in total, four courses took between 2 and 8 weeks, and 6 courses stretched longer than 2 months, according to the timeframes stated in the articles. Fourteen studies did not specify how long their course took.
4. Discussion
In this study, we reviewed 62 articles on leadership education and found great variability on almost all parameters we charted data on. Only 15 articles explicitly defined good leadership, but through a thematic analysis of the goals of the courses, we found nine aspects of what good leadership was. We found neither consensus on the definition of leadership, methods of teaching leadership, nor on methods of evaluation.
As several studies have pointed out [14, 25, 26, 27], clinical leadership does not have a stable definition. This poses a high risk that authors of different papers may use the same word, but each interpret it differently. The lack of consensus on the definition was noted as a barrier to evaluation [28] and also poses a barrier to comparison between the results of the studies. In practical terms, it may limit the applicability of the training in practice, as participants might be trained in some aspects of leadership, while others are left out. The thematic analysis showed a broad range of aspects defining good leadership, inferring that leadership is a multifaceted skill, with more than one way to be an effective leader. Cultural differences are likely to have an impact on the definition of leadership too; concerning how it is taught as well as what role the leader is expected to fill. Some cultures see the leader as an authority, while others see the role more as a steersman of collaboration [29] and this might have contributed to the broad range of data in the thematic analysis.
We also found considerable variability in both the type and duration of interventions, suggesting no consensus on the best way to teach leadership to doctors or medical students. That said, over half of the studies used simulation training. Cited advantages for this choice were that simulation training can facilitate practice of technical and non‐technical skills (NTS) in a controlled environment focusing on the trainee's needs, without risk of harm to patients [30]. Additionally, it was pointed out that simulation‐based training provides an opportunity to develop effective leadership behaviors [31]. Cited limitations to this method were that training simulations alone may give a misleading impression of competency if the skills have only previously been practiced in isolation from the relevant environment, particularly among less experienced operators [30], and that it requires considerable resources to assemble [32].
Didactic lectures, often in combination with other interventions, were also common. Cited reasons for this choice were that lectures were resource effective [32] and that “establishing […] baseline knowledge aids in the discussions of CRM during debriefs of simulation scenarios and in the ED” [33].
The tightly packed curriculum was often cited by studies conducted in medical school as a barrier to implementation [24, 26, 34, 35, 36, 37], as well as a reason for time‐efficient interventions [38, 39, 40, 41]. Some interventions were specifically designed to overcome these barriers, using interventions such as mental rehearsal [42] as a cost‐ and time‐efficient way to improve leadership.
Methods of measuring results of the interventions showed great variability as well. Almost all studies reported positive outcomes, though this could be due to publication bias. Many studies used self‐reported outcomes or analyzed participant satisfaction, which have a high risk of bias. It is also notable that most studies used evaluation methods corresponding to Kirkpatrick level 1 or 2, which “neither assesses the impact of this learning on physicians' actual clinical practice nor the durability of these insights” [43].
Studies that relied on self‐assessment for evaluation noted several limitations, including the risk of bias [32, 44, 45, 46, 47, 48, 49], and participants' lack of awareness of their skill level prior to the intervention [50]. However, these studies also highlighted that the method is sustainable, low budget, and adaptable to user objectives [51]. Studies using blinded assessments by independent reviewers cited this method as a strength [47, 52]. In one study, the team evaluated the leader's performance, which the authors of the study noted may have introduced bias [53]. Some studies utilized a qualitative method of evaluation and cited participants' possible gain of insight as a key reason for this choice [54, 55].
The timing of leadership education varied but it mostly took place either during medical school, or after the second post graduate year. It's unclear if these times are chosen to prepare participants for new roles, or because these time periods tend to be times where medical students or young doctors stay in the same place for a significant time and the course and study design therefore were more feasible.
4.1. Strengths and Weaknesses
Firstly, this study runs a risk of publication bias as it is likely that courses that were rated as less successful were not published. It should also be noted that any number of leadership courses could have been conducted without any article being written about it. Second, the charting of data as well as the data analysis was done by only one person (NV), though evaluated by CC and AN. This runs the risk of bias and/or missed data.
No meta‐analysis was conducted of the papers included in this study, but the overall heterogeneity of the articles, as well as the general lack of quality outcomes, makes for a considerable limitation of the material in this study.
Strengths of this study were the choice of a broad search, as this may have contributed articles to the study, which wouldn't have been found if the search had been narrower. Second, all articles were screened twice and all reviewers were blinded. Another strength was that the data analysis was conducted in collaboration with data analysts at KUB data lab.
5. Conclusion
From the data we can conclude that most studies utilize a descriptive methodology. There has been shown significant variability in the methods of teaching leadership, as well as in the tools used to evaluate said method.
This study had found nine aspects of leadership, which can serve as a preliminary foundation for further research in clinical leadership. However, it will be essential to reach consensus on what aspects define successful clinical leadership more broadly, what situational influences might be relevant for the adaptation of such style, and from there on out, construct an assessment tool that will make it possible to compare educational interventions to one another. This, in turn, could help elucidate what method of teaching was most effective, as well as feasible on cost and resources.
With this large a range of approaches and definitions, one cannot say: this works. Different approaches might work in different contexts in different ways and the question becomes: what works when for whom and why? This should be addressed in future research.
Author Contributions
N.V. has screened all articles for abstract and title, screened all articles in the full text screening, charted the data, and did the data analysis. She also wrote the article. A.N., C.C., and N.S. did the second screening of articles for abstract and title. A.N. and C.C. did the second screening of articles in the full text. All three reviewed charted data, as well as data analysis. They also reviewed and gave feedback on the article. A.M.M. and P.D. have supervised throughout the entire process. They have also reviewed and given feedback on the article.
Funding
The authors have nothing to report.
Disclosure
Patients and/or the public were not involved in the making of this article.
Ethics Statement
The authors have nothing to report.
Conflicts of Interest
Four authors (N.V., A.N., C.C., and N.S.) are or have been medical students at the time of writing and as this study revolves around the education of both doctors and medical students, it could be considered a conflicts of interest.
Supporting information
Supplementary Appendix A This holds the search strategy and search strands for the five databases queried for this study.
Supplementary Appendix B These documents holds the thematic analysis of aspects of good leadership.
Acknowledgments
We want to acknowledge the considerable help from Anne‐Marie Klint Jørgensen, the research librarian at the research unit 15A—Department for anesthesia, surgery and intensive care, as well as from the team at KUB data lab in the making of this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Appendix A This holds the search strategy and search strands for the five databases queried for this study.
Supplementary Appendix B These documents holds the thematic analysis of aspects of good leadership.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.