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Leadership Development in Postgraduate Medical Education

A Systematic Review of the Literature

Sultan, Nabil, MD, MEd; Torti, Jacqueline, PhD; Haddara, Wael, MD; Inayat, Ali; Inayat, Hamza; Lingard, Lorelei, PhD

doi: 10.1097/ACM.0000000000002503
Review: PDF Only

Purpose: To evaluate and interpret evidence relevant to leadership curricula in post-graduate medical education (PGME) to better understand leadership development in residency training.

Method: The authors conducted a systematic review of peer-reviewed, English-language articles from four databases published between 1980 and May 2, 2017 that describe specific interventions aimed at leadership development. They characterized the educational setting, curricular format, learner level, instructor type, pedagogical methods, conceptual leadership framework (including intervention domain), and evaluation outcomes. They used Kirkpatrick Effectiveness scores and Best Evidence in Medical Education (BEME) Quality of Evidence scores to assess the quality of the interventions.

Results: Twenty-one articles met inclusion criteria. The classroom setting was the most common educational setting (described in 17 articles). Most curricula (described in 13 articles) were isolated, with all curricula ranging from one semester to five years. The most common instructor type was clinical faculty (13 articles). The most commonly used pedagogical method was small group/discussion, followed by didactic teaching (described in, respectively, 15 and 14 articles). Study authors evaluated both pre/post surveys of participant perceptions (n = 8) and just post-intervention surveys (n = 9). The average Kirkpatrick Effectiveness score was 1.0. The average BEME Quality of Evidence score was 2.1.

Conclusions: The results revealed that interventions for developing leadership during PGME lack grounding conceptual leadership frameworks, provide poor evaluation outcomes, and focus primarily on cognitive leadership domains. Medical educators should design future leadership interventions grounded in established conceptual frameworks and pursue a comprehensive approach that includes character development and emotional intelligence.

N. Sultan is a nephrologist and assistant professor, Department of Nephrology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

J. Torti is a research associate, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4518-0255.

W. Haddara is an associate professor, Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario; Canada; ORCID: https://orcid.org/0000-0002-9817-5524.

A. Inayat is a neuroscience student, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-1685-9616.

H. Inayat is a neuroscience student, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1601-5269.

L. Lingard is a professor, Department of Medicine, and director, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario; Canada.

Acknowledgements: The authors would like to acknowledge the guidance provided by Western Libraries in regards to conducting the literature search—particularly that of associate librarian John Costella.

Support/Funding: The authors would like to acknowledge both the Centre for Education Research & Innovation (CERI) Collaborative Fellowship that provided funding for the project described in this review, as well as the Division of Nephrology and Department of Medicine at the Schulich School of Medicine & Dentistry.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Nabil Sultan, London Health Sciences Centre – Victoria Hospital, 800 Commissioners Rd E, Room A2-337, London ON N6A 5W9; telephone: (519) 319-2191; e-mail: nsultan@uwo.ca.

© 2018 by the Association of American Medical Colleges