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

Abstract

Abstract Background Leadership is essential in community-based medicine, yet inconsistently taught in Japan’s undergraduate medical curricula. This study aimed to: (1) identify essential community-based leadership competencies using a Delphi approach, (2) develop and pilot a structured curriculum, and (3) evaluate outcomes through a multi-day interprofessional field programme. Methods We adopted Kern’s six-step approach to curriculum development. A literature review extracted preliminary competencies. A two-round Delphi study was implemented with 61 community-based physician leaders in Kagoshima Prefecture, Japan. Round 1 evaluated 26 competencies on necessity, difficulty, and timing (four-point Likert scale; N = 26); Round 2 confirmed 14 revised competencies via dichotomous agreement ( N = 16). Internal consistency was assessed with Cronbach’s α and McDonald’s ω; content validity was assessed with Lawshe’s CVR. A half-day pilot course was then implemented for six medical students. Subsequently, a multi-day interprofessional training camp ( N = 26 reflective reports; N = 11 survey respondents) integrating agricultural field experience, resident interviews, SWOT-based community planning, and interprofessional group work was evaluated through qualitative category analysis of free-text reflective reports and a five-item Likert-scale survey. Results The Delphi study confirmed 14 leadership competencies across four domains. The pilot course revealed transformative shifts in students’ leadership perceptions. In the training camp evaluation, all 14 Delphi-derived competencies were represented in student reports; A1’ (Understanding others, 81%) and D3’ (Local profile analysis and issue identification, 62%) were most frequently observed. Survey items showed high endorsement rates (four-to-five-point responses: 91–100%), with ethnography (M = 4.27) rated marginally higher than SWOT analysis (M = 4.09) as a tool for community understanding. Qualitative analysis further revealed six competency dimensions not captured by the existing 14—notably social capital utilization (54%), SDH clinical integration (50%), and community engagement (46%)—suggesting directions for framework expansion. Conclusions This study identified and validated 14 leadership competencies specific to community-based medicine and developed a corresponding curriculum. Field-based learning integrating medical anthropological approaches and SWOT analysis demonstrated robust alignment with the established competencies while revealing emergent competency domains. The proposed expanded framework—incorporating social capital, SDH, and place-based medicine—may inform broader efforts to integrate comprehensive leadership training into undergraduate and postgraduate medical education.