Is postgraduate leadership education a match for the wicked problems of health systems leadership? A critical systematic review

1a

Learner reaction

Learners’ reactions to program (e.g., satisfaction with learning experience)

2a

Attitudinal changes

Changes in learners’ attitudes and beliefs

2b

Knowledge or skill acquisition

Acquisition of knowledge (e.g., concepts or principles), and/or skills

3a

Behavioural change

Application of knowledge/skills in an educational or practice setting

3b

Learner achievements

Learner academic and professional achievements (publications, presentations, awards, professional positions)

4

Organizational or health systems change

Changes in work units and institutions or in the operation and organization of health systems

Country

US [2, 8, 33, 36–41, 43, 44, 52, 54–56, 76, 81, 82]

18 (58)

UK [23, 32, 45–47, 50, 51]

 7 (22.6)

Canada [48, 53]

 2 (6.5)

Australia [34, 42]

 2 (6.5)

Germany [35]

 1 (3.2)

Netherlands [49]

 1 (3.2)

Education setting/program type

Formal integrated residency program [32, 33, 40, 44, 51, 54, 76, 82]

 8 (25.8)

University-based course/elective programs [8, 35, 37, 39, 41, 43, 47–49, 52, 55]

11 (35.9)

Hospital/academic medical centre-based elective programs [2, 36, 38, 46, 53, 56]

 6 (19.4)

State or nationally organized curricula [23, 34, 42, 50]

 4 (12.9)

Medical society/association program [81]

 1 (3.2)

Unclear or unspecified [45]

 1 (3.2)

Targeted learners/entry level

PGY1 [32, 33, 37, 43, 76]

 5 (16.1)

PGY2 [2, 54]

 2 (6.5)

PGY3 [45, 53]

 2 (6.5)

PGY4 [51]

 1 (3.2)

Multiple PG levels [35, 40, 42, 44, 48, 49, 52, 55]

 8 (25.8)

Chief residents [8, 36, 38, 41]

 4 (12.9)

Senior residents and fellows [39]

 1 (3.2)

Residents (PGY4) and senior physicians [34]

 1 (3.2)

Medical students residents and fellows [81]

 1 (3.2)

Level not specified [23, 46, 47, 50, 56, 82]

 6 (19.4)

Targeted learners/specialties

Internal medicine [2, 43]

 2 (6.5)

Multiple specialties [23, 34–36, 38, 41, 42, 44, 46, 49, 56, 76]

12 (38.7)

Multiple secondary care specialties [32]

 1 (3.2)

Paediatrics [40]

 1 (3.2)

Paediatric anaesthesia [37]

 1 (3.2)

Pathology [39]

 1 (3.2)

Primary care (general practice/family medicine) residents [33, 45, 47, 51, 54]

 5 (16.1)

Psychiatry [48]

 1 (3.2)

Radiology [52, 55]

 2 (6.5)

Neurosurgery [8]

 1 (3.2)

Surgery [53, 82]

 2 (6.5)

Unclear/unspecified [50, 81]

 2 (6.5)

^aStructured multi-professional/management-clinician learning components [32, 44, 82]

(3/31)

Duration

Short-term interventions (1 day–1 month) [2, 35, 36, 38, 41, 53, 55]

 7 (22.6)

Medium-term interventions (intermittent sessions or >1 month <1 year) [8, 39, 43, 47, 48, 52, 81]

 7 (22.6)

Longitudinal interventions (intensive rotations or ≥1 year programs) [23, 32, 33, 37, 40, 42, 44, 49–51, 54, 56, 76, 82]

14 (45.2)

Length varies [34, 46]

 2 (6.5)

Unknown/not specified [45]

 1 (3.2)

Credential

Certificate in Healthcare Management and Leadership [76]

 1 (3.2)

Accredited postgraduate certificate [50]

 1 (3.2)

Diploma in Health and Public Leadership [32]

 1 (3.2)

MSc in Health and Public Leadership [32]

 1 (3.2)

Masters in Public Health [33, 56]

 2 (6.5)

None/not specified [2, 8, 23, 34–49, 51–55, 81, 82]

26 (83.9)