Delphi Study Defines 14 Leadership Competencies for Rural Community Medicine

Leadership is essential in community-based medicine, yet it is inconsistently taught in Japan’s undergraduate medical curricula. A new study published in BMC Medical Education set out to close that gap by identifying the leadership competencies that matter most for rural and community practice, building a curriculum around them, and testing that curriculum in the field with medical students.

The researchers used Kern’s six-step approach to curriculum development. A literature review first extracted preliminary competencies, which were then refined through a two-round Delphi study involving 61 community-based physician leaders in Kagoshima Prefecture, Japan. In Round 1, participants evaluated 26 competencies on necessity, difficulty, and timing using a four-point Likert scale (N = 26). Round 2 confirmed 14 revised competencies through dichotomous agreement (N = 16). Internal consistency was assessed with Cronbach’s alpha and McDonald’s omega, and content validity was assessed with Lawshe’s content validity ratio.

The Delphi process confirmed 14 leadership competencies across four domains. To begin translating the framework into teaching, the team ran a half-day pilot course for six medical students, which the authors report revealed transformative shifts in the students’ perceptions of leadership.

The curriculum was then evaluated at scale through a multi-day interprofessional training camp that integrated agricultural field experience, resident interviews, SWOT-based community planning, and interprofessional group work. The evaluation drew on qualitative category analysis of free-text reflective reports (N = 26) and a five-item Likert-scale survey (N = 11 survey respondents).

The results showed strong alignment between the field programme and the competency framework. All 14 Delphi-derived competencies were represented in student reports. The most frequently observed were A1′ (Understanding others) at 81% and D3′ (Local profile analysis and issue identification) at 62%. Survey items showed high endorsement rates, with four-to-five-point responses ranging from 91% to 100%. Ethnography received a mean rating of 4.27, marginally higher than SWOT analysis at 4.09, as a tool for community understanding.

Qualitative analysis also surfaced six competency dimensions not captured by the existing 14, notably social capital utilization (54%), social determinants of health (SDH) clinical integration (50%), and community engagement (46%). The authors suggest these emergent domains point toward an expanded framework incorporating social capital, SDH, and place-based medicine, which may inform broader efforts to integrate comprehensive leadership training into undergraduate and postgraduate medical education. As a study conducted in a single Japanese prefecture with modest sample sizes in each evaluation component, the findings will require further validation in other settings, but the work offers a concrete, evidence-based starting point for teaching the leadership skills that rural community medicine demands.

Subject of Research: Identifying and evaluating leadership competencies and a field-based curriculum for rural community-based medicine in undergraduate medical education

Article Title: Defining leadership competencies for rural community-based medicine: a Delphi study and field-based curriculum evaluation for undergraduate medical students

Article References: Hamabira, K., Amitani, M., Sakiyama, H., Mizuma, K., Ibusuki, R., & Owaki, T. (2026). Defining leadership competencies for rural community-based medicine: a Delphi study and field-based curriculum evaluation for undergraduate medical students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10131-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10131-y

Keywords: medical education, leadership competencies, Delphi study, rural medicine, community-based medicine, curriculum development, interprofessional training, Kern's six-step approach, SWOT analysis, ethnography, social determinants of health, Japan