Effective leadership is essential in promoting positive workplace cultures and high-quality care provisions in any healthcare environment.[[1]Scammell JME Apostolo JLA Bianchi M Costa RDP Jack K Luiking ML et al.Learning to lead: A scoping review of undergraduate nurse education.J Nurs Manag. 2020; 28: 756-765Crossref PubMed Scopus (7) Google Scholar] Like many skills and abilities, leadership is considered a skill-set that can be taught.[[2]Legg JS Akroyd D Jackowski MB. Radiographer perceptions of managerial transformational leadership levels.Radiol Manage. 2010; 32 (quiz 5-6): 28-34PubMed Google Scholar] It is recognised that leadership skills are a critical necessity for healthcare practitioners.[[3]Johnson SL. Authentic Leadership Theory and Practical Applications in Nuclear Medicine.J Nucl Med Technol. 2019; 47: 181-188Crossref PubMed Scopus (3) Google Scholar] Therefore, the demand for the integration of leadership into the education of front-line healthcare practitioners is increasing.[4Keijser WA Handgraaf HJM Isfordink LM Janmaat VT Vergroesen PA Verkade J et al.Development of a national medical leadership competency framework: the Dutch approach.BMC Med Educ. 2019; 19: 441Crossref PubMed Scopus (7) Google Scholar, 5Blaber A. Harris G Clinical Leadership For Paramedics. 1. ed. McGraw-Hill Education, Maidenhead2014Google Scholar, 6Allen GP Moore WM Moser LR Neill KK Sambamoorthi U Bell HS. The Role of Servant Leadership and Transformational Leadership in Academic Pharmacy.Am J Pharm Educ. 2016; 80: 113Crossref PubMed Google Scholar, 7Citaku F Violato C Beran T Donnon T Hecker K Cawthorpe D. Leadership competencies for medical education and healthcare professions: population-based study.BMJ Open. 2012; 2e000812Crossref PubMed Scopus (23) Google Scholar, 8Blumenthal DM Bernard K Bohnen J Bohmer R. Addressing the leadership gap in medicine: residents' need for systematic leadership development training.Acad Med. 2012; 87: 513-522Crossref PubMed Scopus (140) Google Scholar, 9Curtis EA Sheerin FK Vries J. Developing leadership in nursing: the impact of education and training.Br J Nurs. 2011; 20 (6, 8 Passim): 344Crossref PubMed Scopus (30) Google Scholar] Radiation therapists, radiographers and nuclear medicine technologists work in complex environments, interacting daily with other healthcare professionals and demographically diverse patient groups. The concept of clinical leadership has gained popularity in recent years recognising front line practitioners as agents influencing quality and efficiency in healthcare delivery. While there are opportunities to improve quality and safety in the care of patients, medical radiation science (MRS) professionals also encounter unique challenges which can contribute to stress, impacting the delivery of patient care.[[10]Hunter D Wright C Pearson S. Employing positive psychology to improve radiation therapy workplace culture.J Med Rad Sci. 2019; 66: 139-144Crossref PubMed Scopus (3) Google Scholar] Leadership is taught in many standard business degrees which attracts practitioners due to the absence of formal leadership education in the undergraduate or postgraduate curriculum. While relevant to those aspiring to be in managerial positions, some argue that such degrees may not offer opportunities to develop or enhance emotional or clinical leadership skills.[[11]Boyatzis RE. Managerial and Leadership Competencies.Vision J Busi Perspect. 2011; 15: 91-100Crossref Google Scholar],[[12]Dignam D Duffield C Stasa H Gray J Jackson D Daly J. Management and leadership in nursing: an Australian educational perspective.J Nurs Manag. 2012; 20: 65-71Crossref PubMed Scopus (27) Google Scholar] Taking proactive steps to educate MRS students on leadership is important to shape their future leadership identity and is a fundamental step to advance leadership capacity in the MRS profession. Identity development is a complex process involving systematic education and motivating students to seek leadership experiences and opportunities to grow as leaders. [[13]Day DV. The Difficulties of Learning From Experience and the Need for Deliberate Practice.Indust Org Psychol. 2010; 3: 41-44Crossref Google Scholar] To develop more effective learning opportunities in the profession, leadership can be integrated into educational environments at an undergraduate or postgraduate level where students can acquire profession-specific knowledge, skills and professional attitudes for effective clinical leadership. According to Boyatzis [[11]Boyatzis RE. Managerial and Leadership Competencies.Vision J Busi Perspect. 2011; 15: 91-100Crossref Google Scholar], outstanding leaders require experience, knowledge, and cognitive competencies. Formal leadership education can facilitate more focused learning of cognitive skills such as self-confidence, humility, adaptability, and resilience, all required to work in complex healthcare environments. Positive change can be facilitated by providing students with specific examples that can help broaden students’ views of self and leadership.[[14]Komives SR Owen JE Longerbeam SD Mainella FC Osteen L. Developing a Leadership Identity: A Grounded Theory.J College Student Dev. 2005; 46: 593-611Crossref Scopus (136) Google Scholar] While leadership is widely discussed in healthcare, there is a lack of literature addressing MRS curriculum integration. This educational perspective article draws upon the existing literature to discuss the necessity of leadership development in MRS educational settings. More precisely, we identify the role of registration bodies and discuss curriculum, pedagogical and assessment considerations in leadership development. The need for leadership education in healthcare professions is undisputed. However, the lack of specific educational strategies can lead to ambiguity and a lack of emphasis on leadership learning. Freshwater and Esterhuizen [[15]Freshwater DGI Esterhuizen P Educating leaders for global health care.in: Bishop V Leadership for Nursing and Allied Health Care Professions. McGraw-Hill Education, Berkshire2009Google Scholar] contended that if education is vital to developing transformational leaders, changes to thinking, delivery and healthcare curricula are necessary. In the context of medical residency training, Campbell [[16]Campbell S R Leadership development: Why is it important for radiation oncology residents?.Appl Rad Oncol. 2019; 8: 6-7Google Scholar] argued that the failure to include formal leadership development is a missed opportunity. Daly et al, [[17]Daly J Jackson D Mannix J Davidson PM Hutchinson M. The importance of clinical leadership in the hospital setting.J Healthcare Leadership. 2014; 6: 75-83Crossref Scopus (71) Google Scholar] also commented that many health professionals might not be well prepared for clinical leadership or take leadership roles due to the lack of leadership content within the curricula. Therefore, it is important MRS professions also explore how leadership is currently addressed in educational settings. Several authors have called for leadership education to start early in the career of MRS practitioners. For example, Lovegrove and Long [[18]Lovegrove M Long P. Are radiographers prepared for the clinical leadership challenge?.Radiography. 2012; 18: 230-231Abstract Full Text Full Text PDF Scopus (8) Google Scholar] advocated for the development of leadership capacity in radiography, arguing a need to exploit development opportunities and introduce leadership and followership concepts early in radiographers' educational development levels. Bloom [[19]Bloom RC. Leading the Way in Radiography: Radiography Students' Perceptions of Leadership in the Field.Leadership Opportunities, and Themselves as Future Leaders". 2014; Google Scholar] also supported the notion of incorporating leadership instruction and practical application at an entry-level in the radiography curriculum. In nuclear medicine technology education, Johnson [[3]Johnson SL. Authentic Leadership Theory and Practical Applications in Nuclear Medicine.J Nucl Med Technol. 2019; 47: 181-188Crossref PubMed Scopus (3) Google Scholar] emphasised preparing students to be authentic leaders by developing competencies that lay a concrete foundation for effective leadership. In the radiation therapy profession, the literature highlights the need to build leadership capacity through integration leadership theory. [[20]Chamunyonga C Edwards C Caldwell PJ Rutledge P Burbery J. Leadership in the radiation therapy profession: The importance of understanding the potential benefits and theoretical perspectives.J Med Imaging Radiat Sci. 2020; 51: 535-539Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] A deliberate approach to leadership development is essential and should ideally begin in the pre-registration curriculum. As students progress in their careers, they should broaden their leadership knowledge and experience in various healthcare professionals. The development of effective educational strategies requires more than just the integration of leadership theories proven to be beneficial in improving clinical leadership in healthcare. Leadership education must be consistent, sustainable and requires identifying specific knowledge, skills, and attitudes embedded in the curriculum consistent with competency-based education. The explicit mention of the MRS practitioner's role as a 'leader' can influence leadership development and educational compatible leadership concepts. Long and Spurgeon[[21]Long PW Spurgeon PC. Embedding leadership into regulatory, educational and professional standards.Int J Clin Leader. 2013; 17: 245-250Google Scholar] assert that describing leadership in regulation will drive changes to education and training and that this would ultimately improve leadership capability in healthcare. It means registration/certifying bodies significantly influence leadership capacity and identity in the MRS profession. This view is also supported by the Higher Education England's (HEE's) model and guidelines for health education providers.[[22]England HE. Maximising Leadership larning in th Pre-Registration Healthcare Curricula: Model an Guidelines for healthcare education. London 2018.Google Scholar] A prominent example from the medical literature is the Royal College of Physicians and Surgeons of Canada's Competency Framework (CanMEDS, 2015) [[23]Frank JR, SL Sherbino J CanMEDS 2015 Physician Competency Framework. Royal College of Physicians and Surgeons of Canada, Ottawa2015Google Scholar] whose emphasis on leadership has been widely received among other medical specialities internationally.[[24]Lanys A Krikler G Spitzer RF. The impact of a global health elective on CanMEDS competencies and future practice.Human Resources for Health. 2020; 18: 6Crossref PubMed Scopus (1) Google Scholar,[25]Turner S Seel M Trotter T Giuliani M Benstead K Eriksen JG et al.Defining a Leader Role curriculum for radiation oncology: A global Delphi consensus study.Radiother Oncol. 2017; 123: 331-336Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar To establish the extent to which national registration/certifying bodies mention leadership, we searched documents that describe standards of proficiencies (SoPs), competencies or professional capabilities from five countries (Table 1).Table 1Analysis of international registration/certifying bodies regarding the explicit mentioning of leadership.CountryRegistration/Certifying bodyExplicit mentioningAustraliaMRPBA, Professional Capabilities, 2020NoCanadaCAMRT, Competencies, 2020YesIrelandRadiographers Registration Board, SoP, 2018NoNew ZealandMRTB, Competencies, 2018NoUnited KingdomHCPC, SoP & conduct, 2013YesUnited States of AmericaARRT, certification and registration didactic clinical competency requirements, 2017NoAbbreviations; SoP- Standards of proficiency; ARRT- The American Registry of Radiologic Technologists; CAMRT- The Canadian Association of Medical Radiation Technologist; CORU- The Radiographers Registration Board- under the Health & Social Care Professionals Council; HCPC- Health and Care Professions Council; MRPBA- Medical Radiation Practice Board of Australia; MRTB- Medical Radiation Technologists Board. Open table in a new tab Abbreviations; SoP- Standards of proficiency; ARRT- The American Registry of Radiologic Technologists; CAMRT- The Canadian Association of Medical Radiation Technologist; CORU- The Radiographers Registration Board- under the Health & Social Care Professionals Council; HCPC- Health and Care Professions Council; MRPBA- Medical Radiation Practice Board of Australia; MRTB- Medical Radiation Technologists Board. It is encouraging that some registration bodies explicitly use the terms 'leader' or 'leadership'. Further explanation of what constitutes leadership in the context of the profession will undoubtedly prompt the development of more focused leadership education for MRS. The Health and Care Professions Council (HCPC-UK) is one of the registration bodies that explicitly mentioned 'leadership' in the Standards of Proficiency (SoPs) which every therapy and diagnostic radiographer must meet to become registered in the United Kingdom (UK). In the SoPs published in 2013, standard 13.2 states that 'radiographers must understand the concept of leadership and its application to practice' [[26]HCPC-UK. Standards of Proficiency Radiographers 2013 [ 12 April 2020 ]. Available from: http://www.hpc-uk.org/registrants/standards/download/index.asp?id=51.Google Scholar], which implies that at the point of entry to professional practice, graduates should understand the concept of leadership to develop their practice skills. In recent consultations on the SOPs, changes to this leadership standard were proposed. If approved, practitioners could be expected to understand what leadership means and how it applies to professional practice, including leadership qualities, behaviours, and benefits. The Canadian national professional association and certifying body, the Canadian Association of Medical Radiation Technologists (CAMRT), requires registrants to meet several specific competencies. The national competency profiles highlight the need for practitioners to understand their role as leaders in healthcare.[[27]CAMRT. National Competency Profile for Entry-Level MRTs in Canada 2020 [Available from: https://www.camrt.ca/wp-content/uploads/2020/03/National-Competency-Profile-2019.pdf.Google Scholar] The competency profile specifically identifies MRTs as leaders in the healthcare system, a crucial step in leadership development. In the United States of America, the American Registry of Radiologic Technologists (ARRT) is responsible for national certification and registers nuclear medicine technologists, radiation therapists and radiographers. The didactic and clinical competencies [[28]ARRT. Primary certification and registration didactic and clinical competency requirements: American Registry of Radiologic Technologists; 2017 [Available from: https://www.arrt.org/pages/earn-arrt-credentials/initial-requirements/primary-requirements/education-requirements-primary/didactic-and-clinical-competency-requirements.Google Scholar] are specified for verification of competency in performing clinical duties. These are also used for assessing whether potential registrants have the necessary cognitive knowledge and skills required at entry-level into the profession. However, unlike the Canadian competency profiles, there is no explicit use of the word leadership. In Australia, the Medical Radiation Practice Board of Australia (MRPBA) under the Australian Health Practitioner Regulation Agency defines the knowledge, skills and attitudes for a given competency in the form of professional capabilities. The professional capabilities [[29]MRPBA. Professional Capabilities of Medical Radiation Practice 2020 [Available from: http://www.medicalradiationpracticeboard.gov.au/Registration/Professional-Capabilities.aspx.Google Scholar] do not explicitly mention leadership. This is similar to the competence standards for medical imaging and radiation therapy practice outlined by the New Zealand Medical Radiation Technologists Board (MRTB).[[30]MRTB. Standards of competence for the practice of medical imaging and radiation therapy: Medical Radiation Technologists Board; 2018 [Available from: https://www.mrtboard.org.nz/assets_mrtb/Uploads/2018-Jul-V2-MRT-Competence-Standards.pdf.Google Scholar] The Irish Radiographers Registration Board, which sets the standards for delivering education and training in Ireland for Radiographers and Radiation Therapists, also does not explicitly use the words leader or leadership in the Radiographer Standards Proficiency and Practice Placement Criteria Report 2014. [[31]CORU. Radiographers Registration Board Standards of Proficiency and Practice Placement Criteria 2020 [Available from: https://coru.ie/files-education/rrb-criteria-and-standards-of-proficiency-for-education-and-training-programmes.pdf.Google Scholar] It is important to highlight that despite the lack of explicit labelling of any competencies as leadership by some MRS professional registration bodies, there are robust standards in place that constitute effective communication, professionalism, and ethical practice. For example, clinical competencies may already address resilience, self-awareness, emotional intelligence, interpersonal skills and effective communication principles. Since many of these could be considered part of leadership educational frameworks there could be a reluctance to embed specific leadership education. However, in leadership identity development students and practitioners must identify themselves as leaders, which is not easy if the registration bodies do not use the terms leader/leadership. A research study into maximising leadership in the pre-registration healthcare curricula HEE [[32]England HE. Understanding and Maximising Leadership in Pre-Registration Healthcare Curricula: Research Report. Health Education West Midlands, London2015Google Scholar] suggests it is important to use leadership terminology so that students can value and practice leadership early. There are different approaches to delivering a leadership curriculum. One direction is integrating leadership learning throughout the curriculum.[[33]Ailey S Lamb K Friese T Christopher BA. Educating nursing students in clinical leadership.Nurs Manag (Harrow). 2015; 21: 23-28Crossref PubMed Scopus (16) Google Scholar] Students are introduced to various concepts that seek to advance leadership knowledge, skills, and experience across a three-year or four-year period. An alternative approach is to develop leadership modules that become part of the curriculum delivered at a specific point. [[1]Scammell JME Apostolo JLA Bianchi M Costa RDP Jack K Luiking ML et al.Learning to lead: A scoping review of undergraduate nurse education.J Nurs Manag. 2020; 28: 756-765Crossref PubMed Scopus (7) Google Scholar] However, the timing of leadership theory delivery in either approach is an important consideration. A scoping review by Scammell [[1]Scammell JME Apostolo JLA Bianchi M Costa RDP Jack K Luiking ML et al.Learning to lead: A scoping review of undergraduate nurse education.J Nurs Manag. 2020; 28: 756-765Crossref PubMed Scopus (7) Google Scholar] suggested that leadership theory and competence be introduced early and revisited throughout the programme. In a report published by the HEE [[32]England HE. Understanding and Maximising Leadership in Pre-Registration Healthcare Curricula: Research Report. Health Education West Midlands, London2015Google Scholar], some student participants preferred leadership theory at the beginning of the programme to enable the progression and development of skills throughout the course. Many universities also offer non-specific leadership development opportunities or training courses. For example, foundational units(subjects), such as interprofessional learning (IPL), expose students to a broader perspective, including the healthcare system's complexity; however, such a model is not tailored to a specific profession or discipline. The development of profession-specific empirical evidence to support leadership development frameworks is essential, allowing professional practice to inform leadership development. In the literature, many competency models or conceptual frameworks[[4]Keijser WA Handgraaf HJM Isfordink LM Janmaat VT Vergroesen PA Verkade J et al.Development of a national medical leadership competency framework: the Dutch approach.BMC Med Educ. 2019; 19: 441Crossref PubMed Scopus (7) Google Scholar],[[22]England HE. Maximising Leadership larning in th Pre-Registration Healthcare Curricula: Model an Guidelines for healthcare education. London 2018.Google Scholar],[[34]NHSClinical Leadership Competency Framework. NHS Institute for Innovation and Improvement and Academy of Medical Royal College, Coventry2011Google Scholar] are available which can be used to develop preliminary models or frameworks tailored to the profession's requirements. [[35]Davidson PL Azziz R Morrison J Rocha J Braun J. Identifying and Developing Leadership Competencies in Health Research Organizations: A Pilot Study.J Health Adm Educ. 2012; 29: 135-154PubMed Google Scholar] Formulating a leadership development model is one way to ensure that leadership education addresses the context or dimensions in which leadership development should occur. One useful example developed by the UK's National Health Service (NHS) is the Clinical Leadership Competency Framework (CLCF) [[34]NHSClinical Leadership Competency Framework. NHS Institute for Innovation and Improvement and Academy of Medical Royal College, Coventry2011Google Scholar], designed to promote leadership among clinical practitioners, including radiation therapists and radiographers. Focusing on clinical leadership, the CLCF highlights that one of the key drivers in promoting leadership is ‘promoting greater accountability and ensuring that quality and safe and effective care is delivered.’ The framework emphasises the need for leadership development at all stages in healthcare practitioners' journeys. The paramedic profession has since adopted this model, evidence shows it has been incorporated in the curriculum guidance for student paramedics up to consultant level. [[5]Blaber A. Harris G Clinical Leadership For Paramedics. 1. ed. McGraw-Hill Education, Maidenhead2014Google Scholar] Another example is a model published by the HEE [[22]England HE. Maximising Leadership larning in th Pre-Registration Healthcare Curricula: Model an Guidelines for healthcare education. London 2018.Google Scholar] which also emphasise the need for maximising leadership learning in healthcare pre-registration education. Analysis of these models and frameworks revealed common themes that could inform MRS leadership education. Leadership frameworks often address four standard dimensions or domains. The CLCF [[34]NHSClinical Leadership Competency Framework. NHS Institute for Innovation and Improvement and Academy of Medical Royal College, Coventry2011Google Scholar] defined these as (1) demonstrating personal qualities, (2) working with others, (3) managing improving services and (3) setting direction. These four domains relate directly to the value to ourselves and others when developing leadership capabilities. Figure 1 provides a simplified graphical representation of the common leadership themes that can be adapted to a particular practice area. One such adapted model is a cognitive learning model for clinical nursing leadership[[36]Pepin J Dubois S Girard F Tardif J Ha L. A cognitive learning model of clinical nursing leadership.Nurse Educ Today. 2011; 31: 268-273Crossref PubMed Scopus (32) Google Scholar], which described five critical learning points or learning stages. Awareness of clinical leadership, the integration of leadership in action, leadership with the patient/family and sometimes with colleagues, leadership within teams, and leadership as it applies to the organisation and above. Aside from their use in developing a leadership curriculum, students can directly apply concepts in these models to day-to-day learning to build their own future leadership development plans or to inform them of future professional activities. It is vital to define the knowledge, skills, attitudes/behaviours, and how leadership can be applied to these critical tenants of competencies during curriculum development. Three crucial elements identified in the leadership literature are knowing, doing and being. [[37]Miles JM Scott ES. A New Leadership Development Model for Nursing Education.J Prof Nurs. 2019; 35: 5-11Crossref PubMed Scopus (8) Google Scholar],[[38]Snook SA Nohria N Khurana R DeLong T George B Hill LA et al.The handbook for teaching leadership : knowing, doing, and being. SAGE Publications, Thousand Oaks2012Google Scholar] Knowing is developing an understanding of leadership concepts by introducing principles, leadership theories, concepts, styles, behaviours, characteristics, and assumptions. This component of the leadership curriculum depends on the content addressed in lectures. The curriculum content often varies depending on how a concept is applied in professional registration standards. The list below is an example of what content could be included within the curriculum.•Definition of leadership•Knowledge of leadership theories such as clinical leadership, authentic leadership and transformational leadership concepts. [[20]Chamunyonga C Edwards C Caldwell PJ Rutledge P Burbery J. Leadership in the radiation therapy profession: The importance of understanding the potential benefits and theoretical perspectives.J Med Imaging Radiat Sci. 2020; 51: 535-539Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]•Leadership qualities and behaviours,•Knowledge of cognitive, emotional competencies (self-awareness and self-control) and social intelligence (empathy and teamwork),•Knowledge of contemporary leadership practices in the context of self, teams or organisations,•Leadership impact - clinical leadership is often attributed to improvements in quality and safety and organisational efficiencies Leadership curriculum development should ideally address students' skills and experiences in both university and clinical environments and provide students with opportunities to participate in MRS related tasks to serve as leaders at their level. The literature highlights leadership is an essential part of clinical practice in addition to clinical skills.[[32]England HE. Understanding and Maximising Leadership in Pre-Registration Healthcare Curricula: Research Report. Health Education West Midlands, London2015Google Scholar] MRS students spend a significant proportion of their study off-campus in hospitals and clinics where they engage in authentic learning experiences. It is expected such learning provides students with opportunities to develop leadership skills. When students reflect on their clinical skills, they should also be encouraged to reflect on their clinical leadership experiences. This can also help the students learn about other aspects of leadership, which can influence how students serve as leaders. Other examples of leadership learning opportunities available to students include mentorship roles whereby students can volunteer to assist peers or junior students in practical sessions. They can also volunteer for roles in a professional body and there is evidence this is already occurring in MRS. For example, the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT), provides students enrolled in MRS programs opportunities to volunteer as student ambassadors contributing to the profession whilst enhancing their leadership skills.[[39]ASMIRT. Calling for student ambassadors fir ASMIRT: Online; [cited 2021 14 July]. Available from: https://www.asmirt.org/news-and-publications/latest-news/calling-for-student-ambassadors-for-asmirt/.Google Scholar] The American Society of Radiologic Technologists (ASRT) student leadership development program[[40]ASRT. ASRT Student Leadership Development Program: American Society of Radiologic Technologists [cited 2021 14 September]. Available from: https://www.asrt.org/events-and-conferences/student-leadership-development-program.Google Scholar] is another example of initiatives in place specifically targeting student leadership development. Students in universities may also participate in activities or social groups to gain important leadership attributes relevant to their future roles. For example, when students participate in a cross-cultural experience or exchange program, they travel to other universities or countries where they learn about their health system and culture. Such experiences are vital to leadership growth, and where possible, MRS students should be encouraged to participate. Self-awareness and the ability to reflect on self and individual roles, strengths, and weaknesses are often addressed in leadership curriculum development.[[41]Song EY Chuang J Frakes JM Dilling T Quinn JF Rosenberg S et al.Developing a Dedicated Leadership Curriculum for Radiation Oncology Residents.J Cancer Educ. 2021; Crossref Scopus (1) Google Scholar] Self-awareness is also addressed in many leadership development frameworks, including the CLCF. This is important since working with patients requires cognitive competencies such as emotional intelligence (EI) and contextual intelligence (CI), essential for leaders and health practitioners. EI involves the practitioners' ability to recognise, understand and use emotional information to guide their actions. At the same time, CI is the leader's ability to adapt knowledge or leadership style to a particular context or situation by creating new strategies and deciding on the best actions to take. [[15]Freshwater DGI Esterhuizen P Educating leaders for global health care.in: Bishop V Leadership for Nursing and Allied Health Care Professions. McGraw-Hill Education, Berkshire2009Google Scholar],[42Nye Jr., JS Contextual Intelligence.Leadership Excellence. 2011; 28: 11Google Scholar, 43Kutz MR Bamford-Wade A. Understaning contextual Intelligence: A critical competency for today's leaders Emergence : Complexity and Organization. 2013; 15: 55-80Google Scholar, 44Kutz MR Ball DA Carroll GK. Contextual intelligence behaviors of female hospital managers in the United States.Int J Healthcare Manage. 2018; 11: 155-163Crossref Scopus (6) Google Scholar] A suggestion by Johnson[[3]Johnson SL. Authentic Leadership Theory and Practical Applications in Nuclear Medicine.J Nucl Med Technol. 2019; 47: 181-188Crossref PubMed Scopus (3) Google Scholar] was to include self-awareness and this is an important consideration in MRS education. It is crucial that systematic leadership learning, which includes these and many components of leadership learning, occurs early in the career of MRS practitioners to ensure they have the necessary leadership knowledge, skills and behaviours. Delivery of didactic leadership components can be classroom-based or online lectures, providing students with theoretical leadership concepts. However, several other ways to gaining leadership knowledge and skills exist, such as attending leadership programmes, workshops and continuing education seminars, which are suggested in the literature and team-based projects.[[45]Mahoney J. Leadership skills for the 21st century.J Nurs Manag. 2001; 9: 269-271Crossref PubMed Scopus (41) Google Scholar] Leadership development workshops can be effective in discussing leadership approaches and experiences with students. Effective teaching and learning approaches are often informed by educational theory, feedback from students, and industry stakeholders. To optimise leadership curriculum frameworks specific to MRS it could be beneficial to co-develop curriculum/teaching, learning and assessment methods for leadership with students. Collaboration in teaching and learning is also important and may involve clinical staff members, patients, societies, regulatory/ certifying bodies, academics, and professional advisory boards.[[21]Long PW Spurgeon PC. Embedding leadership into regulatory, educational and professional standards.Int J Clin Leader. 2013; 17: 245-250Google Scholar] An important consideration is to ensure lecturers involved in leadership education have currency and credibility in terms of knowledge and skills concerning evidence-based leadership theories, styles and attributes. [[1]Scammell JME Apostolo JLA Bianchi M Costa RDP Jack K Luiking ML et al.Learning to lead: A scoping review of undergraduate nurse education.J Nurs Manag. 2020; 28: 756-765Crossref PubMed Scopus (7) Google Scholar] Several articles and reports recommended formal assessment of leadership knowledge, skills, and behaviours specific to leadership learning. For example, the HEE research report [[32]England HE. Understanding and Maximising Leadership in Pre-Registration Healthcare Curricula: Research Report. Health Education West Midlands, London2015Google Scholar] recommended assessment of leadership learning, including a review of leadership behaviours in the clinical environment. The report suggested self-assessment of leadership skills as an important consideration for all healthcare students. Simply integrating leadership into the curriculum is not adequate. Till McKimm and Swanwick [[46]Till A McKimm J Swanwick T. Twelve tips for integrating leadership development into undergraduate medical education.Med Teach. 2018; 40: 1214-1220Crossref PubMed Scopus (13) Google Scholar] argued against this proposal asserting leadership development could be marginalised if a formal assessment is implemented. Peake, et al.,[[47]Peake LSP McKimm J Jones S Chapman A Swanwick T Medical leadership and management. An indicative undergraduate curriculum.London Faculty of Medical Leadership and Management;. 2018; Google Scholar] suggested leadership competencies can be assessed using reflective accounts and observations of leadership and followership during clinical placements. One of the challenges highlighted in the literature is the 'already crowded' [[1]Scammell JME Apostolo JLA Bianchi M Costa RDP Jack K Luiking ML et al.Learning to lead: A scoping review of undergraduate nurse education.J Nurs Manag. 2020; 28: 756-765Crossref PubMed Scopus (7) Google Scholar] curriculum and the need to address competencies or capabilities explicitly addressed by registration bodies. Therefore, leadership education may not be considered a priority, particularly when the registration body does not mention leadership. Some might also argue that professionalism and leadership overlap in many areas, making it difficult to define the two explicitly in the curriculum. Hardy and Neve[[48]Hardy LJ Neve H. Professionalism and leadership in medical education: how do they differ and how are they related?.BMJ Leader. 2019; 3: 67Crossref Google Scholar] argued that whilst leadership requires and promotes professionalism, professionalism may not, in itself, qualify one to lead. One way to clarify the leadership elements is to incorporate evidence that ensures leadership development has a place in the curriculum that fits the profession's unique characteristics and practice. However, a common challenge is that leadership competencies and the theory that can drive both scholarship and application require extensive research. As such, leadership empirical studies are necessary to enhance the learners' learning experiences and identify the best approaches for teaching leadership. Though there is a wealth of literature on leadership from many healthcare professions, this gap in the literature can be considered an important avenue for future MRS research. Research from many healthcare professions suggests it is important for leadership to be integrated into education to provide students with the opportunity to acquire theoretical knowledge and develop leadership skills early. However, this requires that professional registration bodies promote future leadership action by explicitly stating leadership in competencies, standards of proficiencies or professional capabilities. The authors recommend that leadership development be integrated into the MRS curriculum with careful consideration of how leadership elements can be embedded in pre-registration educational programmes and how students can learn leadership principles in both university and clinical environments.