Doctoral students in health-related fields are trained for research but poorly prepared for leadership

International survey reveals a lack of consistent leadership development initiatives in health-related PhD programs

A group of five people can be seen sitting around a wooden table. In the foreground, a person holds a pen and an open notepad. In the background, notepads and documents are spread on the table in front of others. The light in the space is natural. All are wearing casual clothes.

Leadership is widely recognized as an essential skill for transforming health systems, but PhD programs in the field offer few initiatives to develop it.

This is the conclusion of a scoping review published in Health Policy by a team of researchers from the Swiss Tropical and Public Health Institute, the University of Basel, Columbia University, and Maastricht University.

Of a sample of 394 articles from three international bibliographic databases (Medline, PsycInfo, and ERIC), all published between 2000 and 2024, researchers found just seven studies addressing the topic.

What is transformational leadership?

1. Fostering collective action: inspires people to look beyond their personal interests in favor of a common goal.

2. Stimulating innovation: encourages people to question established assumptions and to think creatively.

3. Focusing on the long term: prioritizes sustainable development over immediate results, increasing motivation and engagement.

4. Evidence-based decision-making: creates environments where choices are guided by data, even in situations of crisis or uncertainty.

5. Conceptual distinction: contrasts with transactional leadership (based on reward/punishment) and purely hierarchical models.

Lack of evidence and standards

The seven studies were conducted across a wide range of locations: four in the United States, one in New Zealand and Bangladesh, one in Ireland, and one in Iran and the Middle East.

Only one used a validated tool to measure leadership skills: the Multifactor Leadership Questionnaire (MLQ). The rest relied on reflective or descriptive assessments, limiting the comparability and transferability of the findings.

The authors acknowledge that the evidence remains scarce and diverse, and that more robust assessment tools need to be developed, in addition to expanding research to different populations and social and geographic contexts.

Transformational leadership and alternative models

Four of the seven studies focused specifically on transformational leadership, a management style that seeks to inspire, motivate, and engage teams around shared goals.

The other three adopted alternative models, without a single theoretical basis:

Peter Senge’s Shared Vision model
Learning communities
The Nine Best Practices for Leadership Training framework

The diverse range of approaches and absence of a single dominant model outside transformational leadership reinforce the authors’ conclusion that the field has yet to reach a consensus on best practices.

Despite these differences, the programs shared commonalities in some key areas. The most frequently used teaching techniques were group discussions, collaborative learning, and experiential learning, which appeared in all seven studies.

The most frequently covered topics were:

Leadership development: addressed in all 7 studies
Personal and professional growth: 6 out of 7 studies
Teamwork and collaboration: 6 out of 7 studies
Leadership models and frameworks: 6 out of 7 studies

Mentoring: the approach with the greatest measurable impact

Of all the interventions analyzed, mentoring produced the most robust evidence. In just nine weeks, the M³ program (Multi-Modality Mentoring) resulted in a statistically significant improvement in transformational leadership among 54 research fellows studying public health, pharmacy, and medicine at US universities.

Their average MLQ score increased from 61.88 to 65.59 (from a total of 80 points). The study authors calculated the effect size at Cohen’s d = 0.49, which they described as “substantial and desirable,” especially considering the program’s short duration.

“Strengthening transformational leadership in PhD education is key to preparing a future-ready public health workforce,” the authors wrote.

According to the authors, mentoring stands out because it can be adapted to the needs and circumstances of each student. A PhD is the ideal time for this type of training: students are close to entering the job market, but they are still receptive to innovative ideas.

What does it take to lead a research group?

An ongoing issue

The lack of leadership training in health-related fields is nothing new. In 1988, the Institute of Medicine (IOM) published The Future of Public Health, a report containing a warning that remains relevant to this day: “Today the need for leaders is too great to leave their emergence to chance.”

Almost four decades later, the lack of studies on the subject suggests that the issue remains structural. The 2025 review is itself a sign of this, with the authors identifying just seven relevant studies from 24 years of scientific literature.

The review does not provide enough evidence to draw a clear conclusion about which approaches are most effective—the evidence is still scarce. But it raises an important question about how to include transformational leadership development in health-related PhD programs.

Next steps for future research

The authors suggest that future research should investigate whether certain leadership skills are particularly important in specific populations and social and geographic contexts, and how best to develop them.

They also recommend comparative and longitudinal studies to identify adaptable models and measure the long-term impact of leadership training on PhD graduates.

When the most crucial competencies have been identified for each situation, transformational leadership training could be implemented as a central element in educational strategies, with the aim of creating more resilient and equitable health systems—including leadership on issues such as climate change, food security, environmental protection, and social policy.

How to prepare for leadership during your PhD

1. Look for a structured mentoring program: Mentoring is seen as the most effective intervention—programs as short as 9 weeks with personalized mentoring showed measurable gains in transformational leadership (Cohen’s d = 0.49). Look for fellowships, graduate programs, or institutional networks that offer this form of support.

2. Participate in active learning methodologies: Group discussions, real-world problem-solving, and collaborative feedback were present in all seven of the studies analyzed. These practices help develop self-awareness, communication, and decision-making skills, which are central to transformational leadership.

3. Pursue practical experiences beyond academia: The authors recommend seeking out internships and projects at government agencies, NGOs, and in the wider community. These experiences build competencies that are difficult to develop in a purely academic environment, such as the ability to adapt to complex situations and motivate people.

4. Cultivate a collaborative network: Collaborative learning has been identified as one of the key drivers of leadership development. Cultivating relationships with peers, participating in international networks, and contributing to collaborative scientific papers can all help develop leadership skills throughout a doctoral program.

5. Invest in self-awareness and self-reflection: All the programs analyzed included some form of reflection on one’s own leadership style. The authors highlight self-awareness of one’s own strengths and limitations as a prerequisite for exerting a positive influence on teams and systems.

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