Abstract
-
Purpose
Leadership in healthcare is vital, but it remains fragmented within medical school curricula. It is often confined to isolated courses lacking cohesive integration. Using the Medical Leadership Competency Framework (MLCF), this study examines leadership curricula and competencies in Korean medical schools, providing a foundation for educational strategies that enhance leadership development.
-
Methods
We conducted survey among professors responsible for leadership education in medical schools. Our questionnaire assessed leadership competencies and curriculum content. We analyzed responses from 34 medical schools using frequency and content analysis.
-
Results
Leadership-related content in institutional missions, educational objectives, and graduation competencies predominantly aligned with MLCF domains 1 and 2. Leadership courses were primarily offered at the premedical and medical stages, with a strong emphasis on these domains. However, perceptions of the necessity of leadership subcompetencies varied by educational stage, with most considered essential during clinical clerkships. High priority competencies included domains 1 and 2, particularly 2.2 (building and maintaining relationships), 2.4 (working within teams) and 1.4 (acting with integrity). While 61.8% of respondents intended to develop leadership curricula, they emphasized the need to define medical leadership within the Korean context, specify leadership competencies, and design tailored curricula.
-
Conclusion
This study underscores the need for medical leadership education and the development of competency-based curricula that reflect Korea’s healthcare landscape. A well-integrated leadership curriculum can better equip medical students to become future healthcare leaders.
-
Key Words: Leadership curriculum, Leadership competency, Medical schools, Medical Leadership Competency Framework
Introduction
The role of physicians in healthcare is well established, and their influence continues to grow. As modern healthcare systems evolve in complexity, leadership has emerged as a core competency for physicians. Physicians must navigate challenges such as patient-centered care, multidisciplinary collaboration, and healthcare policy development, all of which demand strong leadership skills. To prepare future healthcare leaders, medical schools have begun implementing leadership education, and awareness of its importance is increasing [
1-
3].
While no systematic leadership curricula in medical schools have been reported, various leadership-related courses have been introduced. For example, in 2002, Lee et al. [
4] developed a two-credit course titled “Doctor and leadership” for 2nd-year premedical students. This blended-learning program from 2005 was evaluated after 3 years. Subsequently, Kim et al. [
5] introduced a humanities and social medicine curriculum for leadership development. This curriculum included “Leadership training,” focusing on self- awareness and empathy, and the “Leadership in medical practice,” which covered patient safety and interprofessional collaboration. Notably, short-term intensive leadership training within this curriculum enhanced premedical students’ self-leadership, self-efficacy, and social competencies [
6]. Additionally, Lee et al. [
7] conducted a qualitative analysis of leadership essays submitted by students enrolled in the “Medical leadership” course, providing insights into students’ perceptions of leadership.
Since 2008 in the United Kingdom, the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement introduced the Medical Leadership Competency Framework (MLCF). The MLCF describes the leadership competencies required for doctors to actively participate in the planning, delivery, and transformation of healthcare services [
8]. The third edition, published in 2010, incorporated feedback from various stakeholders, including patients, the public, medical students, and doctors. It outlines five key leadership domains applicable to undergraduate education, postgraduate training, and continuing practice: (1) demonstrating personal qualities, (2) working with others, (3) managing services, (4) improving services, and (5) setting direction. Subsequent frameworks, such as the Clinical Leadership Competency Framework [
9], were released. The Leadership Framework expanded upon the original five domains by introducing two new ones: (6) creating the vision and (7) delivering the strategy [
10]. Each domain comprises four specific competencies, totaling 28 subcompetencies. These frameworks defined the competencies expected of competent doctors, providing examples of learning and development opportunities and practice promoting the implementation of leadership training. Studies have analyzed leadership education in the UK and US medical schools based on these frameworks [
2,
3].
Despite increasing recognition of physician leadership and its role in medical education, Korean medical schools lack research on competency and systematic development of leadership curricula. Therefore, this study aims to analyze the missions, educational goals, and curricula of Korean medical schools aligned with the MLCF. Specifically, this study addresses the following: (1) What competencies do the Korean medical schools’ missions and educational goals align with the MLCF? (2) What competencies do the current curriculum include align with the MLCF? (3) What competencies should be included in leadership curriculum meet with the MLCF? (4) What unmet needs exist in the leadership curriculum for Korean medical schools?
Methods
1. Study design
The Korean Association of Medical Colleges conducted a survey on leadership competencies and curricula via e-mail in September 2024.
2. Study subjects
The study targeted faculty responsible for leadership education or overall medical education at 40 medical schools. This study’s purpose was explained via e-mail. Only those who consented participated in the questionnaire.
3. Survey tools
Four medical education experts developed the questionnaire based on a literature review. The survey, designed for professors overseeing leadership education, included questions on basic information, leadershiprelated missions, educational goals, graduation and leadership competencies, leadership curriculum, plan, and open-ended opinions. To supplement survey data, official medical school websites were reviewed from November to December 2024.
4. Data analysis
We calculated the frequency and percentage of participants’ responses. We analyzed the content of the mission statements, educational goals, and graduation competencies by identifying keywords from the competency descriptions based on the competencies in the MLCF. The key keywords for “1. Demonstrating personal qualities” were self-reflection, self-development, self-management, honesty, and ethics. “2. Working with others” was associated with understanding, trust, collaboration, communication, and teamwork. “3. Managing services” was associated with planning, information, equality, diversity, and performance. “4. Improving services” included problem-solving, analysis, criticism, and innovation. “5. Setting direction” comprised change, evidence, decision-making, evaluation, and responsibility. “6. Creating the vision” was linked to vision, community, nation, and other organizations (institutions). Finally, “7. Delivering the strategy” was related to strategy, organizational management, crisis management, and organizational culture. Keywords related to leadership, professionalism, and social accountability were analyzed separately because of their broad relevance. We conducted statistical analyses using IBM SPSS software (IBM Corp., Armonk, USA), and statistical significance was considered at p<0.05.
5. Ethics statement
This study was reviewed and approved by the Institutional Review Board of CHA University (approval no., 1044308-202406-HR-179-02).
Results
1. Mission, educational objectives, and graduation competencies related to leadership
Among the 40 medical schools surveyed, professors overseeing leadership education programs or overall medical education at 34 medical schools responded. Most respondents held roles as vice deans for education and faculty members in medical education departments. Others were directors of the medical education offices, chairs of medical education departments, and the vice director of the medical education support center. Their roles mainly involved serving as members of the curriculum committee and in humanities and social medicine and medical education.
The 34 medical schools incorporated leadership-related content in their mission statements. Keywords that frequently appeared in their statements included contribution, leadership, dedication, leader, guidance, sharing, and service. These mission statements primarily emphasized contribution to society and leadership in education, research, and service. In their educational objectives, 33 schools incorporated leadership-related elements. These schools used keywords such as responding to changes in the healthcare environment and global perspective. Similarly, 34 schools integrated leadership-related content, highlighting self-directed learning, lifelong learning, problem-solving, team management, and self-assessment as keywords in graduation competencies. These terms were categorized according to the domains of the MLCF, and
Table 1 shows their frequencies. Mission-related terms most frequently aligned with domains 1, 2, and 4. Educational goals were most commonly associated with domains 1 and 2, followed by domains 5, 4, and 6. Graduation competencies primarily corresponded to domain 2, followed by domains 1 and 4.
Medical professionalism exhibited various correlations with the MLCF [
11]. When compared with physician attributes, relevant MLCF subcompetencies included 1.2, 1.3, 1.4, 2.2, 2.3, 2.4, 3.3, 3.4, 4.3, 6.4, and 7.4. Social accountability was primarily linked to MLCF competencies 3, 4, and 5 and subcompetencies 1.4, 3.3, and 4.3 [
12,
13]. Additionally, nine medical schools included leadership-related content in their descriptions of graduate attributes, core values, strategic tasks, subgraduation outcomes, and phase outcomes. The keywords were largely consistent with those previously mentioned. “Leadership” was explicitly mentioned in many cases, and it was often associated with social accountability. In graduation competencies, the term “professionalism” appeared frequently.
A total of 33 medical schools responded offering leadership-related curricula, courses, or extracurricular programs.
Appendix 1 lists the courses explicitly designed to develop leadership competencies. Of these, 11.5% were extracurricular programs, while the rest were regular courses. Leadership-related courses were offered at various stages of medical education as follows: 33% in the premedical stage, 19% in basic medical sciences, 22% in clinical medicine, and 26% during the clinical clerkship.
Table 2 presents the distribution of leadership- related courses based on their alignment with MLCF competencies and their placement in the curriculum. Most courses primarily aligned with MLCF domains 1 and 2, although some courses addressed domains 4, 5, 3, 7, and 6 in that order.
Table 3 presents the demand for leadership subcompetencies at each educational stage in the leadership curriculum. Demand was highest for domains 1 and 2, followed by domains 3, 4, and 5. Conversely, domains 6 and 7 had relatively lower demand. The highest needs of the subcompetencies were: 2.2 (building and maintaining relationships), 2.4 (working within teams), 1.4 (acting with integrity), 1.3 (continuing personal development), and 1.2 (managing yourself). Conversely, the subcompetencies with the lowest needs included: 7.4 (embedding the strategy), 7.3 (implementing the strategy), 7.1 (framing the strategy), 6.4 (embodying the vision), and 6.2 (influencing the vision of the wider healthcare system). By education timing, the subcompetency 1.1 (developing self-awareness) was most emphasized in the premedical course. Conversely, 2.2 (building and maintaining relationships) and 2.4 (working within teams) were prominent in both the premedical course and clinical clerkship. Most other subcompetencies were primarily emphasized during the clinical clerkship stage. However, this differs significantly from the actual timing of the current leadership course offerings.
Additionally,
Fig. 1 compares the percentage of courses covering each subcompetency with the perceived need for them, highlighting these gaps. The subcompetencies with the largest gaps between demand and course coverage were 4.2 (critically evaluating), 3.4 (managing performance), 5.3 (making decisions), and 3.3 (managing people). Conversely, the subcompetencies where the gap between demand and actual course coverage was small included the following: 1.1 (developing self-awareness), 4.4 (facilitating transformation), 1.2 (managing yourself), 5.2 (influencing the vision of the wider healthcare system).
Plans for developing leadership education programs were established at 21 medical schools (61.8%). The priorities were in the following order: concentrating on current courses, focusing on extracurricular development, integrating into the 6-year curriculum revision, and developing new courses (
Table 4). The key needs included defining Korean medical leadership and leadership competencies for medical students, a leadership curriculum design proposal, and faculty development activities.
Discussion
Physicians, being key figures in the healthcare system, naturally work with various healthcare professionals. This role is becoming more crucial and complex, making clinical skills alone inadequate. Medical practice has evolved from focusing on individual-based care to adopting team-based and multidisciplinary approaches. Physicians’ responsibilities are also expanding beyond clinical work to include managing institutions, influencing healthcare policies, and engaging with the community. This is particularly relevant due to the upcoming increase in physician numbers, the growing fragility of certain medical specialties, and the diminishing impact of medical expertise on significant healthcare policies. Despite these changes, efforts to develop leadership skills in physicians have remained stagnant. Leadership education, started in the early 2000s, has become a structured curriculum and remains as individual courses. While leadership skills are included in humanities and social medicine courses, they mainly focus on improving clinical abilities rather than fostering leadership skills intentionally.
Leadership education in medical schools has been required early on [
14,
15], with the first course developed at Keimyung University School of Medicine in 2002 [
4]. In 2011, Kim et al. [
16] reported the first comprehensive leadership curriculum at the Catholic University of Korea College of Medicine [
5]. Various standalone leadership courses have been introduced, such as “Leadership Classes,” “Leadership and Medical Professionalism,” “Leadership Camps,” “Leadership Lectures,” “Patient- Doctor-Society 1,” “Doctor and Leadership,” and “Medical Leadership Course” [
7,
17-
21]. These standalone courses indicate that leadership education is often fragmented, hindering continuous and progressive development of leadership skills during medical training. A more detailed understanding of leadership curricula can be achieved through a systematic investigation of leadership education programs.
Leadership education programs for undergraduate students other than medical schools have been reported since 1997 [
22], followed by reports on leadership education courses [
23]. Since 2015, over 10 papers on this topic have been published annually, along with studies analyzing research trends [
24,
25]. The focus of research has evolved from curriculum development to educational effectiveness and psychology, using quantitative methods. These studies target general education and nursing majors, leadership courses, self-leadership model, and the first stage of leadership identity development [
24]. The findings suggest that universities have been more proactive in leadership education and implementation compared with medical schools. Additionally, leadership education and research have been actively pursued internationally in recent years [
2,
3,
26,
27].
Medical schools have set missions, educational goals, and graduation competencies related to leadership, aligning with MLCF domains 1, 2, and 4. Therefore, medical schools aim to develop leadership skills in students. Additionally, 78 leadership courses have been identified, with 33% offered during the premedical stage. However, the highest demand for leadership education is during the clinical clerkship stage, which does not match the current course offerings. This reveals a significant gap between when leadership skills are needed and when they are taught. Although domains 1 and 2 are in high demand across all stages, some subcompetencies are also needed during the premedical stage. These findings suggest the need for curriculum improvements to better support leadership development, particularly during the clinical clerkship period.
The programs mainly focused on MLCF domains 1 and 2, with less attention to other domains. Demand for leadership education was highest for domains 1 and 2, followed by domains 3, 4, and 5. However, the courses offered were generally insufficient to meet the demand. Specifically, domains 3, 4, and 5 were more relevant to the clinical clerkship stage than the premedical years, requiring efforts to address this gap. Initially, developing educational programs during the clinical clerkship phase is proposed to enhance skills in managing, continuous improvement, and setting direction. Subsequently, designing programs that focus on creating the vision and delivering the strategy is recommended. For example, students could work in teams to design and implement structured activities with clear objectives, refining their approach through active learning. Another method could include creating a vision and developing strategies for a simulated healthcare institution, enabling students to practice leadership decision-making. While implementing these programs during clinical clerkship may be challenging, setting aside designated periods within terms could make these activities workable. Additionally, this study has analyzed subcompetencies based on demand and identified gaps between educational demand and course availability. These findings should be considered when designing leadership education programs, ensuring that curricula meet with the specific leadership skills needed at various stages of medical education.
Many leadership subcompetencies closely align with professionalism and social accountability, which have gained significant attention recently. We also analyzed the relevance of MLCF subcompetencies using wellestablished frameworks. Professionalism was also assessed using the medical professionalism attributes by Cruess and Cruess [
11], identifying related subcompetencies. For instance, “commitment” aligned with subcompetencies 1.2 and 6.4; “trustworthiness” with 2.2 and 7.4; “integrity and honesty” with 1.4 and 6.4; “morality/ethical behavior” with 1.4; “responsibility to the profession” with 1.3, 2.4, 3.3, 3.4, and 7.4, “autonomy” with 2.4; and “teamwork” with 2.4. Social accountability was also examined using the framework by Boelen and Heck [
13], where “quality” was associated with subcompetencies 1.4, 3.3, and 4.3; “cost-effectiveness” with domains 3, 4, and 5; and “equity” with 1.4. These findings suggest that leadership overlaps with and includes aspects of both professionalism and social accountability.
This study has identified several key tasks for Korean medical schools. Since the MLCF was developed in the United Kingdom, its reflects a different healthcare system and sociocultural environment compared to those in Korea. Therefore, defining medical leadership and deriving relevant leadership competencies tailored to Korea’s context are essential, considering factors such as its universal healthcare system, hierarchical organizational culture, and growing emphasis on interdisciplinary collaboration. Therefore, developing a systematic leadership curriculum and implementing leadership education programs specific to each medical school’s circumstances are necessary. Some Korea medical schools have been running leadership programs for over a decade, offering valuable insights for future curriculum development. Additionally, faculty development is crucial to support professors who design and manage leadership education and those interested in enhancing their leadership skills [
28,
29]. This serves as a valuable resource for leadership development in medical schools.
Although this study employed a structured survey design, it included open-ended questions that offer potential for further qualitative analysis. Future studies could explore contextual needs, hidden perceptions, and barriers to leadership education more deeply through in-depth interviews or focus group discussions with students and faculty. This would contribute to the development of more detailed and contextually appropriate leadership education programs in medical schools.
This study explored the current state of leadership education in medical schools and the necessity for leadership competencies. The results show that leadership education is fragmented and mainly emphasizing self-management and teamwork, but does not meet the broader educational needs. These insights will help develop leadership competencies relevant to the Korean context and aid in creating more structured leadership curricula in medical education.
Acknowledgements
None.
Funding
This research was partially supported by Korea Association of Medical Colleges (KAMC), faculty committee.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
Conceptualization: DHL, HC. Data curation: JHI, DHL. Formal analysis: JHI, DHL. Funding acquisition: DHL. Investigation: JHI, HC, WSK. Project administration: DHL. Supervision: HC, WSK. Visualization: EKK. Writing–original draft: all authors. Writing–review & editing: all authors.
Fig. 1. Needs for Specific Competencies
Table 1.Classification of Medical School Missions, Educational Objectives, and Graduation Competencies
Table 1.
|
Category |
MLCF competencies
|
|
1. Demonstrating personal qualities |
2. Working with others |
3. Managing |
4. Continuous improvement |
5. Setting direction |
6. Creating the vision |
7. Delivering the strategy |
|
Mission |
6 |
5 |
0 |
4 |
1 |
0 |
0 |
|
Educational goals |
14 |
13 |
1 |
4 |
5 |
3 |
0 |
|
Graduation competencies |
12 |
32 |
2 |
7 |
2 |
3 |
0 |
Table 2.Proportion of Current Leadership Courses Based on MLCF Competencies
Table 2.
|
Competencies |
Category |
Premedical course |
Basic medical science |
Clinical medicine |
Clinical clerkship |
|
1. Demonstrating personal qualities |
1.1 Developing self-awareness |
61 |
50 |
48 |
43 |
|
1.2 Managing yourself |
61 |
46 |
48 |
46 |
|
1.3 Continuing personal development |
53 |
46 |
45 |
39 |
|
1.4 Acting with integrity |
50 |
50 |
52 |
46 |
|
2. Working with others |
2.1 Developing networks |
39 |
38 |
38 |
43 |
|
2.2 Building & maintaining relationships |
47 |
38 |
45 |
46 |
|
2.3 Encouraging contribution |
42 |
33 |
38 |
43 |
|
2.4 Working within teams |
45 |
38 |
45 |
46 |
|
3. Managing |
3.1 Planning |
18 |
21 |
14 |
18 |
|
3.2 Managing resources |
8 |
17 |
14 |
11 |
|
3.3 Managing people |
13 |
13 |
7 |
4 |
|
3.4 Managing performance |
8 |
13 |
7 |
7 |
|
4. Continuous improvement |
4.1 Ensuring safety |
11 |
21 |
14 |
14 |
|
4.2 Critically evaluating |
13 |
25 |
17 |
14 |
|
4.3 Encouraging improvement and innovation |
11 |
21 |
14 |
7 |
|
4.4 Facilitating transformation |
11 |
25 |
17 |
14 |
|
5. Setting direction |
5.1 Identifying the contexts for change |
18 |
17 |
14 |
11 |
|
5.2 Applying knowledge and evidence |
16 |
17 |
17 |
11 |
|
5.3 Making decisions |
16 |
13 |
14 |
11 |
|
5.4 Evaluating impact |
11 |
13 |
10 |
7 |
|
6. Creating the vision |
6.1 Developing the vision for the organization |
5 |
8 |
7 |
4 |
|
6.2 Influencing the vision of the wider healthcare system |
11 |
25 |
21 |
18 |
|
6.3 Communicating the vision |
11 |
8 |
14 |
4 |
|
6.4 Embodying the vision |
5 |
8 |
7 |
4 |
|
7. Delivering the strategy |
7.1 Framing the strategy |
11 |
13 |
10 |
7 |
|
7.2 Developing the strategy |
11 |
13 |
10 |
11 |
|
7.3 Implementing the strategy |
8 |
13 |
10 |
7 |
|
7.4 Embedding the strategy |
8 |
13 |
10 |
7 |
Table 3.Importance of Leadership Competencies by Educational Stage
Table 3.
|
Competencies |
Category |
Premedical course |
Basic medical science |
Clinical medicine |
Clinical clerkship |
p-value |
|
1. Demonstrating personal qualities |
1.1 Developing self-awareness |
91 |
79 |
56 |
68 |
|
|
1.2 Managing yourself |
74 |
65 |
79 |
85 |
|
|
1.3 Continuing personal development |
62 |
62 |
85 |
97 |
|
|
1.4 Acting with integrity |
76 |
74 |
76 |
91 |
|
|
2. Working with others |
2.1 Developing networks |
74 |
62 |
65 |
91 |
|
|
2.2 Building & maintaining relationships |
82 |
74 |
74 |
94 |
|
|
2.3 Encouraging contribution |
59 |
62 |
56 |
97 |
|
|
2.4 Working within teams |
82 |
71 |
71 |
97 |
|
|
3. Managing |
3.1 Planning |
50 |
50 |
47 |
74 |
|
|
3.2 Managing resources |
26 |
32 |
50 |
71 |
*
|
|
3.3 Managing people |
26 |
29 |
47 |
82 |
**
|
|
3.4 Managing performance |
29 |
35 |
47 |
79 |
*
|
|
4. Continuous improvement |
4.1 Ensuring safety |
12 |
24 |
38 |
94 |
***
|
|
4.2 Critically evaluating |
35 |
47 |
53 |
85 |
*
|
|
4.3 Encouraging improvement and innovation |
12 |
18 |
38 |
85 |
***
|
|
4.4 Facilitating transformation |
6 |
12 |
29 |
85 |
***
|
|
5. Setting direction |
5.1 Identifying the contexts for change |
26 |
26 |
41 |
88 |
***
|
|
5.2 Applying knowledge and evidence |
9 |
24 |
56 |
88 |
***
|
|
5.3 Making decisions |
21 |
29 |
50 |
91 |
***
|
|
5.4 Evaluating impact |
18 |
24 |
32 |
79 |
***
|
|
6. Creating the vision |
6.1 Developing the vision for the organization |
21 |
15 |
24 |
68 |
***
|
|
6.2 Influencing the vision of the wider healthcare system |
15 |
15 |
24 |
65 |
***
|
|
6.3 Communicating the vision |
26 |
18 |
29 |
62 |
*
|
|
6.4 Embodying the vision |
18 |
15 |
24 |
53 |
**
|
|
7. Delivering the strategy |
7.1 Framing the strategy |
21 |
15 |
21 |
53 |
*
|
|
7.2 Developing the strategy |
21 |
21 |
29 |
68 |
**
|
|
7.3 Implementing the strategy |
9 |
9 |
26 |
56 |
***
|
|
7.4 Embedding the strategy |
12 |
9 |
21 |
56 |
***
|
Table 4.Leadership Curriculum Development Plans and Requirements
Table 4.
|
No. of medical schools |
|
Leadership curriculum development plans |
|
|
Existing, centered on current courses |
8 |
|
Existing, focused on extracurricular development |
7 |
|
Existing, to be developed during the 6-year curriculum revision |
4 |
|
Existing, developing new courses |
2 |
|
None (maintaining current courses) |
5 |
|
Requirements |
|
|
Defining Korean Medical Leadership and Leadership Competencies |
6 |
|
Leadership curriculum design proposal |
5 |
|
Development of leadership courses and materials |
3 |
|
National leadership programs for medical students |
3 |
|
Leadership development for the faculty |
3 |
|
Other faculty development activities (workshops, seminars, reports) |
7 |
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Appendices
Appendix 1.
- Number of Courses Presenting Leadership Competencies by Educational Stage
Table
|
Competencies |
Premedical course |
Basic medical science |
Clinical medicine |
Clinical clerkship |
|
1. Demonstrating personal qualities |
26 |
14 |
16 |
15 |
|
2. Working with others |
20 |
11 |
14 |
14 |
|
3. Managing |
7 |
5 |
5 |
5 |
|
4. Continuous improvement |
5 |
7 |
6 |
6 |
|
5. Setting direction |
8 |
4 |
5 |
4 |
|
6. Creating the vision |
6 |
6 |
7 |
5 |
|
7. Delivering the strategy |
4 |
4 |
3 |
3 |
