Abstract
PurposeThere have been a growing number of leadership education programs for physicians. However, debates about the value and efficacy of leadership education in medicine persist, and there are calls for systematic and critical perspectives on medical leadership development. Here, we review evidence on postgraduate leadership education and discuss findings in relation to contemporary evidence on leadership education and practice.MethodWe searched multiple databases for papers on postgraduate leadership development programs, published in English between 2007 and 2017. We identified 4,691 papers; 31 papers met the full inclusion criteria. Data regarding curricular content and design, learner demographics, instructional methods, and learning outcomes were abstracted and synthesized.ResultsThere was modest evidence for effectiveness of programs in influencing knowledge and skills gains in select domains. However, the conceptual underpinnings of the ‘leadership’ training delivered were often unclear. Contemporary theory and evidence on leadership practice was not widely incorporated in program design. Programs were almost exclusively uni-professional, focused on discrete skill development, and did not address systems-level leadership issues. Broader leadership capacity building strategies were underutilized. A new wave of longitudinal, integrated clinical and leadership programming is observed.ConclusionsOur findings raise questions about persistent preparation-practice gaps in leadership education in medicine. Leadership education needs to evolve to incorporate broader collective capacity building, as well as evidence-informed strategies for leadership development. Barriers to educational reform need to be identified and addressed as educators work to re-orientate education programs to better prepare budding physician leaders for the challenges of health system leadership.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-0517-2) contains supplementary material, which is available to authorized users.
Highlights
Concerns about effective leadership are gaining prominence in discourses of health system operations and transformation
Evidence on physician leadership in practice suggests that health systems leadership work is fraught with challenges and paradoxical tensions
Physician leaders often report feeling unprepared for their leadership roles [19, 22], and scholars have questioned whether traditional postgraduate training provides physicians with adequate education for leadership roles [7, 23]
Summary
Concerns about effective leadership are gaining prominence in discourses of health system operations and transformation. The growing emphasis on the importance of health systems leadership coincides with the extraordinary challenges facing global health systems that must contain costs while meeting public expectations for high quality care at a time of rapid technological advances, demographic shifts, and rising income inequality [1, 5]. It is in this environment that there is growing contention for physician engagement in health systems leadership given their influence over healthcare quality and resource utilization [6,7,8,9]. Physician leaders often report feeling unprepared for their leadership roles [19, 22], and scholars have questioned whether traditional postgraduate training provides physicians with adequate education for leadership roles [7, 23]
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