Exploring the role of leadership education in undergraduate medicine: a scoping review

Abstract

Background:
Leadership is increasingly recognized as a core competency in medical education, central to the CanMEDS framework and vital for patient safety, interprofessional collaboration, and healthcare innovation. Despite this, undergraduate medical curricula have traditionally underemphasized leadership training, leaving students underprepared for the complex non-clinical demands of modern healthcare.

Purpose:
This scoping review explores the role, design, and impact of leadership education in undergraduate medical education. The objective was to synthesize current initiatives, assess their effectiveness, and identify gaps and opportunities for strengthening leadership development.

Methods:
A scoping review following the JBI methodology and reported in accordance with the PRISMA-ScR checklist was conducted. A comprehensive search of PubMed/MEDLINE was performed in May 2025 for English studies published between 2015-2025. Two reviewers independently screened titles, abstracts, and full texts using Covidence, with discrepancies resolved by consensus. Data were charted using a standardized spreadsheet capturing study design, population, intervention characteristics, and outcomes. Findings were synthesized thematically.

Results:
Of the 23 studies included, quantitative (35%) and mixed-methods (30%) designs predominated, with additional qualitative and commentary-based approaches. Most studies originated from the United States (43%), though international representation was noted. Leadership interventions varied, with workshops and simulations (43%) being the most common, alongside structured curricula (22%) and extracurricular programs (22%). Target populations ranged across pre-clerkship (30%), clerkship (22%), and combined cohorts (26%). Outcomes demonstrated improvements in leadership skills, confidence, identity development, and sustained behavioral changes. Frameworks such as CanMEDS, the Medical Leadership Competency Framework, and Leadership Identity Development model were variably applied. Key themes included the superiority of experiential learning, value of reflection and feedback, and challenges of curricular integration, faculty development, and student engagement.

Conclusions:
Leadership education in undergraduate medicine is diverse but fragmented, with no consensus on optimal models. Evidence supports systematic, competency-based integration emphasizing experiential, reflective, and interprofessional learning. Embedding leadership training early and longitudinally within curricula is essential to prepare future physicians for the evolving demands of healthcare systems.