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Letters to the Editor

Leadership Training in Graduate Medical Education

Sadowski, Brett MD; Hartzell, Joshua MD, MS-HPEd

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doi: 10.1097/ACM.0000000000002823
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To the Editor:

We read with interest the systematic review of leadership development curricula within graduate medical education (GME) settings by Sultan and colleagues.1 We published a similar systematic review2 containing 19 of the 21 articles reviewed by Sultan and colleagues. Based on differences in search terms (1,259 papers in their initial search vs 3,413 in ours) and acceptance criteria, we included an additional 31 reports on GME leadership curricula. The breadth of our review can provide readers with an expanded view of what has been published related to GME leadership curricula. We believe both reviews are significant and provide important information for those developing GME or, for that matter, any leadership curricula. We wanted to highlight a few similarities and differences in the reviews and additional items that may be valuable to readers.

Our results showed similar findings with regard to rates of different pedagogical methods, trainees, and content. Unlike Sultan and colleagues, we did not categorize curricula under the leadership domains of character, emotional intelligence, and cognitive skills, but doing so is a useful approach and may be a model for future curricula development and reviews. We did identify which curricula addressed specific areas included in the Academy of Medical Royal Colleges’ Medical Leadership Competency Framework.3 This framework provides another potential model for subsequent reviews and those developing curricula.

The 2 reviews’ characterizations of quality were dissimilar as we categorized 11 of 52 papers (21%) as the highest quality (grade 4 or 5 in the Best Evidence Medical Education guide4), but Sultan and colleagues had none in that range. Furthermore, only 4 of the papers we deemed to be grade 4 or 5 were even included in the review by Sultan and colleagues. We also highlighted 11 potential best practices when developing leadership curricula that could serve as a valuable guide for those developing curricula. Of these best practices, “the importance of faculty development” and “considering interprofessional involvement” were 2 that stuck out as missing in the review by Sultan and colleagues. Furthermore, we specifically recommended reporting criteria for leadership curricula that we think will allow for subsequent papers to be more easily compared and replicated.

We applaud the continued interest in leadership development and recognize that there is a growing body of literature that will build upon both reviews.

Brett Sadowski, MD
Gastroenterology fellow, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland; [email protected]
Joshua Hartzell, MD, MS-HPEd
Internal medicine residency program director, National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, Maryland.


1. Sultan N, Torti J, Haddara W, Inayat A, Inayat H, Lingard L. Leadership development in postgraduate medical education: A systematic review of the literature. Acad Med. 2019;94:440–449.
2. Sadowski B, Cantrell S, Barelski A, O’Malley PG, Hartzell JD. Leadership training in graduate medical education: A systematic review. J Grad Med Educ. 2018;10:134–148.
3. Black C, Spurgeon P, Douglas N, Clark J. Medical Leadership Competency Framework: Enhancing Engagement in Medical Leadership. 2010.3rd ed. Coventry, UK: NHS Institute for Innovation and Improvement, Academy of Medical Royal Colleges.
4. Hammick M, Dornan T, Steinert Y. Conducting a best evidence systematic review. Part 1: From idea to data coding. BEME Guide No. 13. Med Teach. 2010;32:3–15.
Copyright © 2019 by the Association of American Medical Colleges