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Evidence-based medical leadership development: a systematic review
  1. Oscar Lyons1,
  2. Robynne George2,
  3. Joao R Galante3,4,
  4. Alexander Mafi5,
  5. Thomas Fordwoh5,
  6. Jan Frich6,
  7. Jaason Matthew Geerts7,8
  1. 1 Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  2. 2 Royal United Hospital Bath NHS Trust, Bath, UK
  3. 3 Department of Medical Education, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4 Cardiology Department, Buckinghamshire Healthcare NHS Trust, Amersham, UK
  5. 5 University of Oxford Medical School, University of Oxford, Oxford, UK
  6. 6 Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
  7. 7 Research and Leadership Development, Canadian College of Health Leaders, Ottawa, Ontario, Canada
  8. 8 The Business School (formerly Cass), University of London, London, UK
  1. Correspondence to Dr Oscar Lyons, Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK; oscar.lyons{at}nds.ox.ac.uk

Abstract

Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. Using Ovid MEDLINE, we conducted a database search using both free text and Medical Subject Headings. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews. We applied the Medical Education Research Study Quality Indicator (MERSQI) and the Joanna Briggs Institute (JBI) Critical Appraisal Tool to determine study reliability, and synthesised results using a meta-aggregation approach. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the MERSQI was 8.5/18 and the median critical appraisal score according to the JBI was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

  • medical leadership
  • development
  • doctor
  • trainees
  • consultant

Data availability statement

Data are available upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/leader-2020-000360

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @oscarlyonsnz, @J_Frich, @jaasongeerts

  • Contributors OL, RG and JRG planned the review. OL, RG and TF screened studies for inclusion. OL, RG, JRG, AM and TF abstracted and coded studies. OL, RG, JRG, AM, TF, JF and JMG contributed to analysis, writing and editing the manuscript.

  • Funding Oscar Lyons was supported during this work by a Rhodes Scholarship, a Goodger and Schorstein Research Scholarship (University of Oxford) and the Shirtcliffe Fellowship (Universities New Zealand)

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.