Addressing Conceptual Gaps in Physician Leadership Development: A Critical Perspective.

There is a focus on leadership in organizational discourses and physicians are playing an increasing leadership role in healthcare and medical education (HC&ME). However, there is a need to reconcile continuing considerable investment in leadership development and only modest evidence (although growing) of its impact on outcomes, especially at the organizational and systems level. The purpose was to identify conceptual issues related to leadership development in HC&ME that are likely contributing to the intent-action and impact gap. Using Jabareen's methodology for developing a conceptual framework, the concepts were identified through an iterative process of identifying key words associated with the main ideas in leadership development. Informed by grounded theory principles, the "text" critically analyzed included, a) narrative review of interdisciplinary literature on leadership development in HC&ME and across industries, b) focused review of adult education principles and adult development theories, c) insights from conferences and conversations with thought leaders, and d) notes on experiences in leadership praxis, research, and offering and receiving leadership development. The eleven conceptual considerations under three broad categories include, a) philosophical - clarity of purpose and discerning leader and leadership development, b) theoretical/foundational - a lack of leadership development theory, limited influence of non-dominant leadership discourses, paucity of conceptual frameworks, and c) pragmatic /pedagogical - teaching and learning aspects with skewed utilization of education, training and development pathways, predominance of Western notions of leadership, restricted considerations informing content, need for a nuanced consideration of context, integrating individual and joint development, and leveraging readiness and timing. Consideration of these conceptual issues informs a strategic approach at the organizational and individual level to the design, development and delivery of leadership programs for sustained learning and effectiveness. Research using a collaborative interdisciplinary approach is likely to systematically synthesize high-quality evidence to enhance leadership development work.