literature review teaching strategy

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• BMC Med Educ

Methods for teaching evidence-based practice: a scoping review

Camilla marie larsen.

1 Health Sciences Research Centre, UCL University College, Niels Bohrs Allé 1, 5230 Odense M, Denmark

2 Department of Physiotherapy, UCL University College, Niels Bohrs Allé 1, 5230 Odense M, Denmark

4 Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark

Anne Seneca Terkelsen

Anne-marie fiala carlsen.

3 Research Service, UCL Library, UCL University College, Niels Bohrs Allé 1, 5230 Odense M, Denmark

Hanne Kaae Kristensen

5 Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense, Denmark

Associated Data

The data used and analysed during the current scoping review are available from the corresponding author on reasonable request.

This scoping review aims to gather and map inspiration, ideas and recommendations for teaching evidence-based practice across Professional Bachelor Degree healthcare programmes by mapping literature describing evidence-based practice teaching methods for undergraduate healthcare students including the steps suggested by the Sicily Statement.

A computer-assisted literature search using PubMed, Cinahl, PsycINFO, and OpenGrey covering health, education and grey literature was performed. Literature published before 2010 was excluded. Students should be attending either a Professional Bachelor’s degree or a Bachelor’s degree programme. Full-text articles were screened by pairs of reviewers and data extracted regarding: study characteristics and key methods of teaching evidence-based practice. Study characteristics were described narratively. Thematic analysis identified key methods for teaching evidence-based practice, while full-text revisions identified the use of the Sicily Statement’s five steps and context.

The database search identified 2220 records. One hundred ninety-two records were eligible for full-text assessment and 81 studies were included. Studies were conducted from 2010 to 2018. Approximately half of the studies were undertaken in the USA. Study designs were primarily qualitative and participants mainly nursing students. Seven key methods for teaching evidence-based practice were identified. Research courses and workshops, Collaboration with clinical practice and IT technology were the key methods most frequently identified. Journal clubs and Embedded librarians were referred to the least. The majority of the methods included 2–4 of the Sicily Statement’s five steps, while few methods referred to all five steps.

Conclusions

This scoping review has provided an extensive overview of literature describing methods for teaching EBP regarding undergraduate healthcare students. The two key methods Research courses and workshops and Collaboration with clinical practice are advantageous methods for teaching undergraduate healthcare students evidence-based practice; incorporating many of the Sicily Statement’s five steps. Unlike the Research courses and workshop methods, the last step of evaluation is carried out partly or entirely in a clinical context. Journal clubs and Embedded librarians should be further investigated as methods to reinforce existing methods of teaching. Future research should focus on methods for teaching EBP that incorporate as many of the five steps of teaching and conducting EBP as possible.

Dizon et al. state that healthcare can be inefficient, ineffective and/or dangerous when it is not based on current best evidence [ 1 , 2 ]. Therefore, to ensure the quality of healthcare, it is important to implement evidence-based practice (EBP) in all health professional curricula, so that future health professionals learn the fundamentals of research and the application of evidence in practice [ 2 ].

Several definitions of EBP have been suggested in recent years. The scientific evidence was initially developed within medicine, but as many health professionals have embraced an evidence-based way of practice the Sicily Statement [ 3 ] suggested that the original term “evidence-based medicine” should be expanded to “evidence-based practice” in order to reflect a common approach to EBP across all health professions.

The Sicily Statement gives a clear definition of EBP together with a description of the minimum level of educational requirements and skills required to practice in an evidence-based manner. This makes the underlying processes of EBP more transparent and distinguishes between the process and outcome of EBP [ 3 ].

In order to fulfil the minimum requirements of teaching and conducting EBP, the Sicily Statement puts forward a five-step model: (I) asking a clinical question; (II) collecting the most relevant evidence; (III) critically appraising the evidence; (IV) integrating the evidence with one’s clinical expertise, patient preferences and values to make a practice decision; and (V) evaluating the change or outcome [ 4 ].

Internationally, EBP skills are essential requirements in clinical practice among both medical doctors as well as among other health professionals. Healthcare students are mainly taught the first three steps of the Sicily Statement’s five-step model. The last two steps are rarely taught, and students and graduates thus lack competencies in applying their knowledge in the clinical setting during or after graduation [ 5 , 6 ].

In terms of healthcare policy and ambitions in Denmark, it was decided in 2015 that Professional Bachelor Degree healthcare students were to contribute to the development of an evidence-based way of working, a faster implementation of new knowledge in practice, and to the development of greater patient involvement and patient safety in the Danish healthcare system [ 7 ]. The Professional Bachelor’s degree is awarded after 180–270 ECTS and includes a period of work placement of at least 30 ECTS. The programmes are applied programmes. They are development-based and combine theoretical studies with a practical approach. Examples of professional bachelor degree holders are nurses. The Danish title is Professionsbachelor and the English title is Bachelor [ 8 ]. In Denmark the University College institutions solely provide professional bachelor degree educations. Master degrees are awarded at the Universities.

Based on the Sicily Statement students should be able to reflect, ask questions, gather knowledge, critically appraise, apply and evaluate various kinds of knowledge at the end of their course. The aim is that all Professional Bachelor Degree healthcare students across disciplines of nursing, physiotherapy, occupational therapy, radiography, and biomedical laboratory science develop common EBP qualifications in order to contribute towards the development of evidence-based healthcare [ 9 ]. In order to ensure shared prerequisites and mutual understanding of the EBP concepts before entering theoretical or clinical inter-professional education, further knowledge about how to teach EBP across disciplines is required [ 9 ]. By teaching the fundamental principles of EBP, students will develop their EBP skills and ability to put them into practice in their studies and as future graduates.

Previously, some systematic reviews were conducted summarising various educational interventions or strategies for teaching EBP to undergraduate healthcare students [ 2 , 10 – 12 ].

In a review from 2014, Young and colleagues stated that multifaceted interventions integrated into clinical practice contributed to the greatest improvements in EBP knowledge, skills, and attitudes [ 2 ]. In line with this, Kyriakoulis et al. suggested that a combination of interventions, such as lectures, tutorials, workshops, conferences, journal clubs, and online sessions was best suited for teaching EBP to undergraduate healthcare students [ 10 ]. However, the majority of the articles in both reviews synthesized information from interventions or strategies aimed at medical students at various educational levels. Only a few articles elicited information about educational interventions and strategies aimed at undergraduate healthcare students in the disciplines of nursing, physiotherapy, occupational therapy, radiography, and/or biomedical laboratory science. However, two recent reviews have specifically addressed EBP teaching for undergraduate nursing students [ 11 , 12 ]. A systematic review investigated the effectiveness of specific educational methods and found an effect on student knowledge, attitudes, and skills but could not draw a conclusion as to the advisability of one of the methods [ 11 ]. A literature review sought to identify knowledge experiences on teaching strategies from qualitative studies in nursing EBP education to enhance knowledge and skills and points to a limited focus on the use of EBP teaching strategies. Additionally, the study points to the need for more qualitative research investigating interactive and clinically integrated teaching strategies. Despite both reviews being well-informing, a broad scope when mapping updated EBP teaching methods and strategies across healthcare bachelor educations will further qualify future interdisciplinary practices [ 11 , 12 ].

In order to implement the most effective ways of teaching EBP across healthcare undergraduate students, an investigation of existing literature on the subject needs to be undertaken. For identifying, mapping and discussing key characteristics in the literature a scoping review is the better choice [ 13 ].

Aim, objectives and review question

The aim of this scoping review is to gather and map inspiration, ideas, and recommendations for teachers implementing EBP across Professional Bachelor Degree healthcare programmes by mapping existing literature describing EBP teaching methods, including the five steps of EBP suggested by the Sicily Statement, [ 3 ] regarding undergraduate healthcare students.

The primary question of the scoping review is: “Which EBP teaching methods, including The Sicily Statement’s steps of teaching and conducting EBP, have been reported in the literature with respect to undergraduate healthcare students in classrooms and clinical practice?”

Definitions

Classroom is defined as a room where classes are taught in a school, college or university [ 14 ].

Clinical practice refers to the agreed-upon and customary means of delivering healthcare by doctors, nurses and other health professionals [ 15 ].

To ensure a systematic methodology, The Joanna Briggs Institute Reviewers’ Manual - Methodology for JBI Scoping Reviews has been used throughout the scoping review process [ 16 , 17 ].

Inclusion criteria

Participants.

Literature which included undergraduate healthcare students in the disciplines of nursing, physiotherapy, occupational therapy, radiography, and biomedical laboratory science was selected to ensure applicability and relevance to similar scientific disciplines at other institutions of higher education. The undergraduate students should be attending either a Professional Bachelor’s degree or a Bachelor’s degree programme.

Methods for teaching EBP including The Sicily Statement’s steps of teaching and conducting EBP was the main concept to be investigated in the review. That is; literature describing either recommendations of EBP teaching methods, evaluations of EBP teaching methods, teacher and/or student perceptions of EBP teaching and learning methods, or qualifications obtained when learning the principles of EBP.

Literature describing methods for teaching EBP conducted in a classroom setting, in clinical practice as part of the education, or in a combination of classroom and clinical practice was included in the review.

Exclusion criteria

In the period up to 2010, the Bachelor Degree healthcare educations began to conform to European requirements regarding evidence-informed and evidence-based education [ 18 ].

A maximum time frame (2010–2018) was applied, determined by the amount of available literature/research studies and requirements of updated teaching strategies [ 19 , 20 ]. Therefore, literature published before 2010 was excluded.

Literature including undergraduate students in other health disciplines such as medicine or dentistry was not reviewed as the structure of their education is based on another paradigm. Nor was literature including participants such as graduates, RN-to-BSN students, and trained health personnel accepted for inclusion as they were considered as postgraduates, not comparable to undergraduate students. With the primary aim of gathering ideas and inspiration for teaching EBP, literature that focused on issues other than methods for teaching EBP was excluded, as well as literature in languages other than English, Danish, Norwegian, or Swedish.

Search strategy

To identify literature relevant to our research question, the databases MEDLINE via PubMed, CINAHL Complete, and PsycINFO (both via EBSCO) were systematically searched. These databases cover both health and education and are available to the primary local target audience of this scoping review. Because of time limitations only the multidisciplinary European database, OpenGrey, was searched in the attempt to find unpublished literature. The searches were conducted May 9th, 2018.

As recommended in The Joanna Briggs Institute Reviewers’ Manual [ 16 , 17 ], the search was conducted in three steps in collaboration with a research librarian.

• Step 1: The databases PubMed, covering the field of biomedicine and CINAHL, covering nursing and allied health literature were searched using the keywords: ‘teaching methods’, ‘teaching’, ‘learning methods’, ‘learning’, ‘teaching strategies’, ‘learning strategies’, ‘undergraduate’, ‘undergraduate education’, ‘student’, ‘biomedical laboratory scientist’, ‘medical laboratory scientist’, ‘medical laboratory technologist’, ‘medical laboratory technologists’, ‘radiographer’, ‘occupational therapist’, ‘physiotherapist’, ‘nurse’, and ‘evidence-based practice’.

Specific search queries, all databases

• Step 3: The reference lists of identified studies were searched for additional studies.

Study selection

All search results from the databases were imported to the web-based bibliographic management software, RefWorks 2017 by ProQuest. After exclusion of duplicates and records before 01.01.2010, two reviewers independently screened titles and abstracts of the remaining articles for relevance in relation to the research question and the inclusion and exclusion criteria. Afterwards, all full-text articles were further checked for relevance by two independent reviewers. Any inconsistencies between the two reviewers regarding study selection for final inclusion were resolved by discussion with a third reviewer.

Data collection

Data from the included articles were extracted using two data extraction tools as recommended in The Joanna Briggs Institute Reviewers’ Manual [ 16 , 17 ]. The first data extraction tool comprised study characteristics, while the other data extraction tool comprised methods for teaching EBP.

Prior to the process of extracting data from the included articles, a pilot test using the data extraction tools was conducted by one reviewer assessing nine articles. To ensure agreement between reviewers, a second reviewer checked the same articles. Any disagreements about the content or use of the data extraction tools were discussed and resolved.

One reviewer then extracted relevant data from all included articles to the data extraction tools. Two other reviewers split the same articles among them and extracted data using the same data extraction tools. As a final step, the first reviewer went through all extracted data from all of the included articles with each of the other reviewers to ensure comparability and completeness in the final data extraction tools.

Synthesis and analysis of results

The data extraction tools formed the basis of the final presentation of the results in two tables consisting of “Study characteristics” and “Key methods for teaching EBP, the Sicily Statement’s five steps of teaching and conducting EBP and context”. Study characteristics included author, year of publication, title, journal, country of origin, study design, study participants, methods for teaching EBP, and main study findings. The key methods for teaching EBP were identified through a thematic analysis. All full text articles were read and every teaching method found was listed. Through a revision of all teaching methods listed, seven themes were found that described the most prominent teaching methods, which were named “Key methods for teaching EBP”. All methods were then divided into one of the key methods for teaching EBP. In some articles, more than one teaching method was described. In that case, the teaching method most frequently described was selected and categorised under the relevant key method. Through full-text revision the Sicily Statement’s steps of teaching and conducting EBP and the context (classroom, clinical practice or a combination of both) in which the teaching took place was found. To further clarify the content of the two tables all results listed were described narratively. All tabulated data, except for the key methods for teaching EBP identified in Table  3 , have been cited directly from the articles.

Key methods for teaching undergraduate healthcare students EBP, the Sicily Statement’s five steps of teaching and conducting EBP and context

Literature search

The database search returned 2220 records: PubMed ( n  = 1469), Cinahl ( n  = 527), PsycINFO ( n  = 173), and OpenGrey ( n  = 51) (Fig.  1 ). Records published before 01.01.2010 and duplicates were removed, which left 1280 records to be screened by title and abstract. Based on relevance, 1088 records were excluded and 192 records were found eligible for full-text assessment. In accordance with the inclusion and exclusion criteria, 111 articles were excluded. The excluded articles concerned study participants other than undergraduate healthcare students (graduates, RN-to-BSN students, trained health personnel), study participants from other healthcare disciplines (medicine, dentistry, midwifery), issues other than methods for teaching EBP (simulation teaching, community health nursing, EBP beliefs, etc.), and full-text articles not available in English, Danish, Norwegian, and Swedish (French, Chinese). In agreement with the other reviewers, 81 studies were finally included in the scoping review.

Modified PRISMA flow diagram illustrating the scoping review selection process

Study characteristics

Study characteristics are presented in Table  2 . All studies were spread across the years 2010–2018. Almost half of the studies ( n  = 40) were conducted in the USA, followed by Canada ( n  = 8), Norway ( n  = 7), Australia ( n  = 6), England ( n  = 6), Sweden ( n  = 3), China ( n  = 2), Finland ( n  = 2), Spain ( n  = 2), Greece ( n  = 1), Iran ( n  = 1), Lebanon ( n  = 1), Scotland ( n  = 1), and Taiwan ( n  = 1). The study designs were primarily qualitative ( n  = 55), while 23 of the studies were quantitative, and three of the studies used a mixed method. The majority of the participants were nursing students ( n  = 72), followed by a combination of nursing students and students from other healthcare disciplines ( n  = 5), nursing and physiotherapy students ( n  = 1), physiotherapy students and students from other healthcare disciplines ( n  = 1), occupational and physiotherapy students ( n  = 1), and physiotherapy students only ( n  = 1).

Study characteristics ( N  = 81)

Key methods for teaching EBP, the Sicily Statement’s five steps of teaching and conducting EBP and context

Table ​ Table3 3 presents the key methods for teaching EBP, the Sicily Statement’s five steps of teaching and conducting EBP, and the context. Seven key methods for teaching EBP were identified: Thirty-two studies described “Research courses and workshops”. “Collaboration with clinical practice” was identified 14 times followed by “IT technology” ( n  = 8), “Assignments” ( n  = 5), “Participation in research projects” ( n  = 5), “Journal clubs” ( n  = 2), and “Embedded librarians” ( n  = 2). In addition, 13 studies described various theories of teaching and learning. These are not elaborated on as the theme is not considered within the objective of this scoping review.

In Table ​ Table3 3 the vast majority of the studies ( n  = 69) referred to one or more of the Sicily Statement’s five steps of teaching and conducting EBP. Eleven studies referred to all five steps. Thirty-one studies referred to three or four steps, while 17 studies referred to two of the steps, and ten studies described one step. Twelve studies had no description of any of the steps.

The steps most often referred to were step two, three, and four. Step two, “Collect the most relevant evidence”, was mentioned in 58 studies. Step three, “Critically appraise the evidence”, was referred to in 55 studies, while step four, “Integrate the evidence with one’s clinical expertise, patient preferences, and values to make practice decision”, was mentioned in 51 studies. Step one, “Ask a clinical question”, and step five, “Evaluate change or outcome” was referred to in 36 and 14 studies, respectively. Seven out of the eleven studies referring to all of the Sicily Statement’s five steps were identified under the key methods “Research courses and workshops” and “Collaboration with clinical practice”.

The context in which the studies were conducted was primarily classroom settings ( n  = 52). Twenty studies described context as a combination of classroom and clinical practice, and nine studies were conducted in clinical practice.

Out of the 68 studies which included the seven key methods, 24 out of 32 “Research courses and workshops” were conducted in classrooms, while “Collaboration with clinical practice” was conducted in a combination of classroom and clinical practice ( n  = 6), clinical practice ( n  = 5), or classrooms ( n  = 3). “IT technology” was used in classrooms ( n  = 6) or clinical practice ( n  = 2). “Assignments” were conducted in classroom settings only ( n  = 5), while “Participation in research projects” took place in a combination of classroom and clinical practice ( n  = 3), classroom ( n  = 1) or clinical practice ( n  = 1). “Embedded librarians” ( n  = 2) and “Journal clubs” ( n  = 2) both took place in classroom settings.

This study provides an overview of existing EBP teaching methods including The Sicily Statement’s steps of teaching and conducting EBP with respect to undergraduate healthcare students both in classrooms and in clinical practice.

It is beyond the scope of this review to interpret all the findings of the included studies. The findings discussed below are the key methods most frequently identified in the thematic analysis: “Research courses and workshops” and “Collaboration with clinical practice”, as well as the key methods most positively referred to in main findings of the studies: “IT technology”, “Embedded librarians”, and “Journal clubs”. Despite the scarce use of the last three methods (“IT technology”, “Embedded librarians”, “Journal clubs”) these can however provide ideas for how to teach EBP in the future. Furthermore, the scoping review provides useful information as to which of the Sicily Statement’s five steps of teaching and conducting EBP are taught in the various methods and whether one particular method is more useful and applicable than others in a particular learning setting, depending on the context and the learning outcomes. Lecturers, senior lecturers and others who teach EBP at undergraduate healthcare educational institutions can benefit from this information and gain inspiration and ideas for teaching EBP. We are aware that other studies have addressed issues such as teachers’ competencies required for teaching EBP, which we do consider important in order to standardise and improve education in EPB. Interestingly, a study has identified specific sets of EBP core competencies for teachers, which are classified within the 5-step model of EBP [ 101 ]. However, since our primary focus was on methods for teaching EBP to undergraduate healthcare students the aspect of teacher’s competencies has not been further investigated.

Overall, the first 4 steps of the Sicily Statement could more easily be identified. However the last and fifth step proved to be more difficult to identify which often is the case. Furthermore, our results tend to point to the fact that the fifth step is often more theoretically linked at the undergraduate level and that a more specified implemtation and evaluation of the EBP process takes place at a more advanced level.

Research courses and workshops

Research courses and workshops were the most frequently used methods for teaching EBP. The frequent use of this method is in agreement with the systematic review by Kyriakoulis et al., where eight of the 20 methods for teaching EBP were research courses, workshops or similar sessions [ 10 ] and Young et al., where three out of five methods used for teaching evidence-based healthcare (EBHC) were workshops [ 2 ]. The majority of the studies concerning “Research courses and workshops”, referred to three or more of the Sicily Statement’s five steps of teaching and conducting EBP [ 10 , 23 , 26 , 31 , 33 , 40 , 42 , 44 , 47 – 49 , 53 , 55 – 57 , 59 , 76 , 90 , 91 , 96 , 97 , 100 ]. Despite the fact that the fifth step was included in some studies, it was not clear what was covered by the evaluation process, and additionally, if it was part of the students’ assignment work alone or if there was a link to clinical practice. The majority of the research courses and workshops were conducted in classrooms. According to Young et al., EBHC courses can improve appraisal skills in nurses, occupational therapists and physiotherapists, among others [ 2 ]. However, further assessments and analyses of the courses and workshops found in this scoping review must be made to ensure that the content and outcomes are applicable in similar contexts.

Collaboration with clinical practice

In this scoping review, the key method for teaching EBP, “Collaboration with clinical practice” was identified 14 times in the thematic analysis. In comparison, “collaboration with clinical practice” is only mentioned once as a method for teaching EBP in the review by Young et al. [ 2 ] and not mentioned in the systematic review by Kyriakoulis et al. [ 10 ]. The results of this scoping review suggest that collaboration with clinical practice is a frequently used method for teaching EBP with respect to undergraduate healthcare students. The rare use of this method in the review by Kyriakoulis et al. and the review by Young et al. might be explained by the type of participants included in these reviews. Only two studies included undergraduate students in the disciplines of nursing, physiotherapy or occupational therapy: in the review by Young et al. and the review by Kyriakoulis [ 2 , 10 ]. Along this line, a review on teaching EBM to medical students found weak and inconsistent results from a limited number of studies on the effect of clinically integrated methods on knowledge, attitudes, and skills [ 102 ]. Collaboration with clinical practice might be more fundamental among undergraduate students in the disciplines of nursing, physiotherapy or occupational therapy, compared to undergraduate students in medicine primarily included in the other reviews [ 2 , 10 ].

Half of the studies identified in relation to “Collaboration with clinical practice”, referred to four or five of the Sicily Statement’s steps [ 38 , 43 , 70 , 73 , 80 , 87 , 89 , 93 ]. In two of the studies, the steps were taught directly in clinical practice as part of the students’ clinical education [ 70 , 93 ], and unlike the research courses and workshops methods, the last step of evaluation of change or outcome is carried out either partly or entirely in a clinical context. The main findings of all eight studies indicate that collaboration with clinical practice is an effective way of teaching EBP, both with the combination of classrooms and clinical practice settings and in clinical practice settings alone. Despite being a recommended strategy in the literature, a recent literature review points to the fact that EBP teaching strategies including clinical activities in nursing students seems less prioritised [ 12 ].

IT technology

The key method, “IT technology”, described tools, such as mobile devices, video resources and websites, among others, used in classrooms or clinical practice for seeking information in relation to EBP. In clinical practice, mobile devices were used to seek information regarding EBP search strategies, critical appraisal of clinical guidelines [ 66 ], and specific task-oriented information in relation to clinical practice [ 36 ]. Despite the reported improvement in knowledge and skills in relation to EBP and appraisal of clinical guidelines, the use of mobile devices was reported as low [ 66 ]. In classrooms, the use of IT technology as a method for teaching EBP was reported as mainly positive. Today, most students have access to IT equipment and this technology could be integrated in classrooms and clinical practice to seek information regarding EBP. In the review by Kyriakoulis et al. the results support our findings; that IT technology can be an effective method for teaching EBP with respect to undergraduate healthcare students [ 10 ].

Journal clubs

“Journal Clubs” as a method for teaching EBP was only described in two studies in this scoping review. However, the findings indicated that the method improved students’ skills in reading articles and understanding evidence-based nursing [ 60 ], and promoted competenceis needed to deliver evidence-based care [ 58 ]. The studies included two and three steps, respectively, proposed by the Sicily Statement [ 3 ]. Additional steps may advantageously be incorporated into future journal clubs to ensure the quality of healthcare. Young et al. referred to four reviews describing a positive effect of journal clubs as a method for teaching EBP [ 2 ]. However, none of the reviews included Professional Bachelor Degree healthcare students. Further studies must be conducted to assess the effectiveness of journal clubs as a method for teaching EBP in Professional Bachelor Degree healthcare courses and to study the opportunity of incorporating all of the Sicily Statement’s five steps for teaching and conducting EBP.

Embedded librarians

In two studies librarians were introduced to teach students information literacy [ 74 , 77 ]. Librarians are experts in this field and are able to teach students the skills essential to EBP [ 74 ]. Librarians can support students in establishing and managing effective search techniques and help with reviewing and critiquing the information found. Thus, students develop information literacy skills as required in practice [ 77 ]. Research librarians who are embedded as part of a research course for teaching undergraduate healthcare students EBP may be an effective way of ensuring a complete introduction to the Sicily Statement’s five steps of teaching and conducting EBP. The first three steps can be taught in classrooms, followed by practical exercises in the last two steps in clinical practice.

Implications for practice

The majority of the key methods found for teaching EBP were “Research courses and workshops” and “Collaboration with clinical practice”, whereas “Journal Clubs” and “Embedded librarians” were identified only twice. The frequent use of research courses and workshops as methods for teaching EBP may stem from a tradition of classroom lectures and is a relatively manageable way to teach EBP. The findings from this scoping study however suggest that other methods for teaching EBP with respect to undergraduate students exist. Journal clubs could be incorporated as a supplement to classroom lectures or as part of collaboration with clinical practice. Librarians may advantageously be introduced in research courses and workshops. The librarians can help students gain control of EBP definitions and concepts, and master search techniques before entering clinical practice. The effect of journal clubs and embedded librarians on students’ EBP competencies should however be investigated further before being incorporated into Professional Bachelor’s Degree curricula.

EBP education based on the Sicily Statement’s five steps, demanded both internationally and nationally, implies an introduction to all of the Sicily Statement’s five steps of teaching and conducting EBP at undergraduate level [ 5 , 6 , 9 ]. At present, the majority of the methods found for teaching EBP only include 2–4 steps. In line with these results, a recent review found that the majority of evaluated EBP educational interventions are focused on a single step (step 3, critically appraising evidence) of the five steps of teaching and conducting EBP [ 103 ]. This research adds to the statement that an effort must be made to incorporate all five steps of the Sicily Statement in an educational and cooperative way in order to ensure that undergraduate healthcare students are qualified to work in an evidence-based manner.

We did not review available assessment methods for evaluation of EBP education interventions or programmes in this study. The additional importance of this field and the apparent lack of valid evaluation methods have been extensively highlighted in other studies and needs to be taken into account when applying methods for teaching EPB [ 104 , 105 ].

Strengths and limitations

The scoping review presents an updated overview of existing methods for teaching EBP with respect to undergraduate healthcare students, including study specific recommendations for teaching methods to be used in future curricula. It follows recommended guidelines for a priori design requirements and transparent reporting [ 13 , 16 ].

Limitations are however found in relation to the search strategy. Our search did not include literature published before 2010 and due to time constraints, a limited number of databases were searched, which entails the risk that not all relevant literature was identified. Furthermore, the search terms used identified primarily undergraduate nursing students, despite a thorough search for all undergraduate students in the disciplines of nursing, physiotherapy, occupational therapy, radiography, and biomedical laboratory science. Other search terms might have captured these health disciplines to a greater extent. An alternative explanation for the large occurrence of studies regarding nursing students could be that there is a greater publishing tradition in this field. However, the methods for teaching EBP can to a certain extent, be introduced to undergraduate students in the other health disciplines.

Consistent with our objective, this scoping review has provided an extensive overview of literature describing methods for teaching EBP regarding undergraduate healthcare students. The two key methods most often identified were “Research courses and workshops” and “Collaboration with clinical practice”. Despite the first method often being used in this scoping review, as well as in other reviews, fewer of the Sicily Statement’s five steps of teaching and conducting EBP were referred to, and if the fifth step of evaluation of change or outcome was included, the description of content was often unclear.

On the contrary, “Collaboration with clinical practice”, the second most used teaching method, more often referred to four or five steps, making this method an effective approach for teaching EBP while ensuring incorporation of several of the steps. Unlike the Research courses and workshop methods, the last step of evaluation is carried out partly or entirely in a clinical context.

Overall, our results tend to show that the evaluation step is often theoretically linked at the undergraduate level. Despite the small number of studies describing ‘Journal clubs’ and ‘Embedded librarians’, these teaching methods could advantageously be incorporated in the classroom context and could ensure a complete introduction to all five steps.

On the basis of our findings, we argue that future research should focus on identifying methods for teaching EBP that incorporate as many of the Sicily Statement’s five steps of teaching and conducting EBP as possible. Journal clubs and embedded librarians could be further looked into as methods to support the more established methods for teaching EBP across all undergraduate healthcare disciplines.

Acknowledgements

The authors would like to thank research assistants Morten Puck, Martin Mau and Susanne Pommergård for their valuable work in reviewing and editing tables.

Authors’ contributions

AST, HKK, CML contributed in designing the study. AST and AFC conducted the literature search. AST, HKK and CML screened the titles and abstracts. AST, HKK, CML extracted data from the studies. AST and HKK performed a synthesis of study results. AST, HKK, CML and AFC interpreted the data. CML and AST drafted the manuscript. All the listed authors have contributed to and approved the final manuscript.

This project is funded by internal funds granted by Health Sciences Research Centre, UCL University College, Odense, Denmark. The funding part had no role in the design of the study, the collection, analysis and interpretation of the data, or in writing the manuscript.

Availability of data and materials

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Camilla Marie Larsen, Email: kd.lcu@2almc , Email: kd.lcu@almc .

Anne Seneca Terkelsen, Email: kd.lcu@etsa .

Anne-Marie Fiala Carlsen, Email: kd.lcu@acfa .

Hanne Kaae Kristensen, Email: kd.lcu@rkkh .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators

Affiliation.

• 1 About the Authors Cecile Breytenbach, MCur, RN, is a nurse educator at Life Health Care College, East London, Port Elizabeth, South Africa. Wilma ten Ham-Baloyi, PhD, RN, is a research associate at the Faculty of Health Sciences, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. Portia J. Jordan, PhD, MBA, RN, RM, is an associate professor and head of department, Department of Nursing Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. The authors acknowledge librarian Madeleine Clare for assisting with the search strategy. For more information, contact Dr. ten Ham-Baloyi at [email protected].
• PMID: 28622266
• DOI: 10.1097/01.NEP.0000000000000181

Aim: The aim of the study was to explore and describe the best available literature on evidence-based teaching strategies that can be used by nurse educators.

Background: Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. Although some teaching strategies for nurse educators were identified, no integrative literature review was found summarizing the best teaching strategies for nurse educators.

Method: Integrative literature review.

Results: Sixteen studies were included encompassing eight teaching strategies (e-learning, concept mapping, Internet-based learning, web-based learning, gaming, problem-based learning, case studies, and evidence-based learning). Of these, three (concept mapping, Internet-based learning, and evidence-based learning) significantly increased student knowledge.

Conclusion: All teaching strategies increased knowledge in some way, indicating that faculties should use a variety of teaching strategies. However, more research is needed to compare the impact of a variety of teaching strategies and the best use of different teaching strategies.

PubMed Disclaimer

Similar articles

• Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol. MacKinnon K, Marcellus L, Rivers J, Gordon C, Ryan M, Butcher D. MacKinnon K, et al. JBI Database System Rev Implement Rep. 2015 Jan;13(1):14-26. doi: 10.11124/jbisrir-2015-1694. JBI Database System Rev Implement Rep. 2015. PMID: 26447004
• Teaching nursing concepts through an online discussion board. Hudson KA. Hudson KA. J Nurs Educ. 2014 Sep;53(9):531-6. doi: 10.3928/01484834-20140820-01. J Nurs Educ. 2014. PMID: 25138567
• NICU nurse educators: what evidence supports your teaching strategies? Pilcher J. Pilcher J. Neonatal Netw. 2013 Jul-Aug;32(4):281-4. doi: 10.1891/0730-0832.32.4.281. Neonatal Netw. 2013. PMID: 23835547
• Promotion of critical thinking by using case studies as teaching method. Popil I. Popil I. Nurse Educ Today. 2011 Feb;31(2):204-7. doi: 10.1016/j.nedt.2010.06.002. Epub 2010 Jul 23. Nurse Educ Today. 2011. PMID: 20655632 Review.
• Can concept mapping be used to promote meaningful learning in nurse education? Irvine LM. Irvine LM. J Adv Nurs. 1995 Jun;21(6):1175-9. doi: 10.1046/j.1365-2648.1995.21061175.x. J Adv Nurs. 1995. PMID: 7665784 Review.
• Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study. Al-Daken L, Lazarus ER, Al Sabei SD, Alharrasi M, Al Qadire M. Al-Daken L, et al. SAGE Open Nurs. 2024 Mar 20;10:23779608241233146. doi: 10.1177/23779608241233146. eCollection 2024 Jan-Dec. SAGE Open Nurs. 2024. PMID: 38510754 Free PMC article.
• Development of an interactive elective "altered anatomy" for students as part of the Z-curriculum according to the NKLM 2.0. Koch K, Hirt B, Shiozawa-Bayer T, Königsrainer A, Fusco S, Wichmann D. Koch K, et al. GMS J Med Educ. 2023 Jun 15;40(4):Doc43. doi: 10.3205/zma001625. eCollection 2023. GMS J Med Educ. 2023. PMID: 37560042 Free PMC article.
• Comparing the pharmacology knowledge and performance of nurses and nursing students in the use of information resources in pediatrics wards: An observational study. Shahzeydi A, Joonbakhsh F, Ajoodaniyan N, Khaksar S, Kalhor F, Sabzghabaee AM, Kalhor R. Shahzeydi A, et al. SAGE Open Med. 2022 Dec 2;10:20503121221135397. doi: 10.1177/20503121221135397. eCollection 2022. SAGE Open Med. 2022. PMID: 36478694 Free PMC article.
• Clinical teaching practices of nurse educators: An integrative literature review. Gcawu SN, van Rooyen D. Gcawu SN, et al. Health SA. 2022 Sep 30;27:1728. doi: 10.4102/hsag.v27i0.1728. eCollection 2022. Health SA. 2022. PMID: 36262921 Free PMC article. Review.
• Evaluating Evidences of Effectiveness in Web-Based Nursing Education Program. Wang J. Wang J. Comput Math Methods Med. 2021 Nov 25;2021:3901916. doi: 10.1155/2021/3901916. eCollection 2021. Comput Math Methods Med. 2021. Retraction in: Comput Math Methods Med. 2023 Jul 26;2023:9761010. doi: 10.1155/2023/9761010. PMID: 34868340 Free PMC article. Retracted.

Publication types

• Search in MeSH

LinkOut - more resources

Full text sources.

• Ovid Technologies, Inc.
• Wolters Kluwer

Other Literature Sources

• scite Smart Citations

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators

Breytenbach, Cecile; ten Ham-Baloyi, Wilma; Jordan, Portia J.

About the Authors Cecile Breytenbach, MCur, RN, is a nurse educator at Life Health Care College, East London, Port Elizabeth, South Africa. Wilma ten Ham-Baloyi, PhD, RN, is a research associate at the Faculty of Health Sciences, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. Portia J. Jordan, PhD, MBA, RN, RM, is an associate professor and head of department, Department of Nursing Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. The authors acknowledge librarian Madeleine Clare for assisting with the search strategy. For more information, contact Dr. ten Ham-Baloyi at [email protected] .

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website ( www.neponline.net ).

The authors declare no conflict of interest.

The aim of the study was to explore and describe the best available literature on evidence-based teaching strategies that can be used by nurse educators.

BACKGROUND 

Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. Although some teaching strategies for nurse educators were identified, no integrative literature review was found summarizing the best teaching strategies for nurse educators.

METHOD 

Integrative literature review.

RESULTS 

Sixteen studies were included encompassing eight teaching strategies (e-learning, concept mapping, Internet-based learning, web-based learning, gaming, problem-based learning, case studies, and evidence-based learning). Of these, three (concept mapping, Internet-based learning, and evidence-based learning) significantly increased student knowledge.

CONCLUSION 

All teaching strategies increased knowledge in some way, indicating that faculties should use a variety of teaching strategies. However, more research is needed to compare the impact of a variety of teaching strategies and the best use of different teaching strategies.

Full Text Access for Subscribers:

Individual subscribers.

Institutional Users

Not a subscriber.

You can read the full text of this article if you:

• + Favorites
• View in Gallery

Readers Of this Article Also Read

Objectives and outcomes: the fundamental difference, evidence-based teaching practice in nursing education: faculty perspectives and practices</strong>', 'kalb kathleen a.; o\'conner-von, susan k.; brockway, christine; rierson, cindy l.; sendelbach, sue', 'nursing education perspectives', 'july-august 2015', '36', '4' , 'p 212-219');" onmouseout="javascript:tooltip_mouseout()" class="ejp-uc__article-title-link"> evidence-based teaching practice in nursing education: faculty perspectives and ..., nln core competencies for nurse educators: are they present in the course..., nurse educators’ guide to clinical judgment: a review of conceptualization,..., nursing faculty roles in prelicensure baccalaureate clinical preceptorships.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

The Impact of Effective Teaching Strategies on the Students'Academic Performance and Learning Outcome A Literature Review Literature Review Education

Related Papers

Ramatu Ussif

International Journal of Scientific Research in Multidisciplinary Studies

Christopher D C . Francisco

The principal aim of the researcher was to test the impact of instructional practices of teachers on students' academic performance. To achieve this aim, the researcher used a sample size of 55 teachers and 295 students in private schools in the City of Meycauayan, Bulacan during the school year 2018-2019. The primary data gathering tools used in the study was a standardized questionnaire Instructional Practices Survey adopted from Valentine (2000) on determining teachers' instructional practices and a documentary analysis from DepEd Order no.8, s. 2013 also known as the Classroom E-Record to determine the point average of the respondents' status of academic performance. The collected data were analyzed and treated statistically through the use of Statistical Packages for Social Sciences (SPSS). Results revealed that the instructional practices affect the students' academic performance in English, Mathematics, Science, Filipino, and Araling Panlipunan to a varying extent. This means that for every unit improvement in the instructional management practices mentioned could generate a certain increase in students' academic performance. The analysis of variance revealed a greater value than the significance level set at 0.05. We cannot reject the null hypothesis. We may safely conclude that the planning, teaching, and assessment practices of the teachers did not produce significant combined effects on the academic performance of students on the five content subjects in the curriculum. The study recommended that school principals may conduct frequent teachers' assessment, training needs assessment to identify the needs of teachers in terms of their profession.

Future Expert Solutions

Dr. Qais Faryadi

Dr. Ahmed A A M Raba'

This study aimed to find out the impact of effective teaching strategies on producing fast and good learning outcomes. It also aimed to determining the role of the study variables (the place graduation, the college where he taught in, the number of published research, the number of conferences and workshops , participation in the Good Samaritan program, teaching experience and academic rank) in producing fast and good Learning outcomes. To achieve these purposes, the researcher used a 25-item questionnaire distributed among lecturers at An-Najah National University. Additionally, the researcher interviewed five lecturers randomly selected from the same faculties at An-Najah National University as well. The data were collected and analyzed using SPSS to answer the questions of the study. The researcher found out that there was positive impact of effective teaching strategies on producing good and fast learning outcomes. Also, the results showed that there were no statistical significant differences at (α = .05) in the impact of effective teaching strategies on producing fast and good learning outcomes due to the study variables. Based on these findings, the researcher recommended the lecturers to use effective teaching strategies via continual improvement and updating their teaching strategies.

Aysel Saricaoglu , ARİF SARIÇOBAN

ARİF SARIÇOBAN

Romblon State University Research Journal

Joefel Libo-on

Determining the effects of four teaching strategies on the academic performance of senior high school students was the main objective of this study. The quasi-experimental design, specifically the equivalent pretest-posttest design was used. A grade-11 class was divided into four sections, the three sections served as the experimental classes subjected to game-based, outcome-based, and technology-based teaching strategies, and one section served as the control group who undertook the traditional teaching method. Results showed that all groups were at a &quot;satisfactory&quot; level of performance before the treatment. Although the means of the experimental groups increased a little than that of the control group after the treatment, still all groups were at a &quot;satisfactory” level. Before treatment, all groups were comparable, but difference was observed after the treatment. Improvement from pretest to posttest performance of the experimental groups and control group was found ...

Student achievement has become a hot topic in education today, especially with increased accountability for classroom teachers. The ultimate goal for any teacher is to improve the ability level and prepare students for adulthood. Defining student achievement and factors that impact progress is critical to becoming a successful teacher. Student achievement measures the amount of academic content a student learns in a determined amount of time. Each grade level has learning goals or instructional standards that educators are required to teach. There are many variables that can impact successful student achievement, but the most critical are learning disabilities and teaching methods. Teaching Method can best be defined as the type of principal & methods used for Instruction. There are many types of teaching methods, depending on what information or skill the teacher is trying to convey. The objective of this present study was investigating the effect of Teaching method on the Academic Achievement of school going children " semi urban area's schools of Lucknow city. A sample of 60 students of 9 th class in semi urban area's schools-Jivan jyoti academy and divine public school. A questionnaire to elicit information on general and specific Information pertaining to the respondent. The data obtained was considered & analyzed manually. The percentage with respect to various independent variables & dependent variable were calculated manually. Introduction Teaching Method can best be defined as the type of principal & methods used for Instruction. There are many types of teaching methods, depending on what information or skill the teacher is trying to convey. Class participation demonstration, recitation and memorization are some of the teaching methods being used. When a teacher deciding in their method, they need to flexible and willing to adjust their style according to their student, student success in their academic achievement based on effect on effective teaching methods. According to study statistically significant difference teaching strategies of teacher used by the learner & the teacher. While the relationship between the compensation strategy & the academic success of the student was found to have a negative meaningful relation with academic success. However, the students the teachers were met cognitive strategies & compensation strategies. For effective teaching to take place, a good method must be adopted be a teacher. A teacher has many options when choosing a style, by which to teach. The teacher may write lesson plan of their own, borrow plans from other teacher, or search online, or within book for lesson plan. When deciding what method to use, a teacher needs to consider student background, knowledge, environment & learning goals. Teacher are aware that student's have different way of absorbing information & of demonstrating their knowledge. Teacher often use to techniques which cater to multiple learning style to help students retain information & strength in understanding. A variety of strategies & method are used to ensure that all students have equal opportunities to learn. A lesson plan may be carried out in several ways.

ABUBAKAR OBILAN

Mariyam Nihaadh

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

RELATED PAPERS

mariz saguran

lakhwinder mann

Kalpina Kumari

Nana yaw Dabreh

Asian Journal of Education and Social Studies

Ariel San Jose

kebby mwanamoomba

Khawla M Badwan

Mediterranean journal of social sciences

Melody modebelu

Musarrat Yaseen

International Journal of Humanities, Social Sciences and Education

Mavis Mhlauli

Alfonso Echazarra , daniel salinas , Giannina Rech , Vanessa Denis

Tauseef Haider

Zenodo (CERN European Organization for Nuclear Research)

Mehmet AKTÜRK

International Online Journal of Education and Teaching

VEDA YAR YILDIRIM

Ramoshweu S Lebelo

Global Journal of Human Social Science Research

Fauzia Khurshid

sajjad hussain

Eurasian Journal of Educational Research

Ibrahim Yıldırım

Language Teaching Research Quarterly

Azizeh Chalak

Pingge Roni

Humanities & Social Sciences Reviews

Fitzgerald Fabelico , BONIMAR AFALLA

Johnson Mavole

Oirc Journals , moraa Elmeldha

Palarch’s Journal of Archaeology of Egypt / Egyptology.

Ramakrishna Avvaru

Dr. Hisham Hanfy

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Autonomous and controlled motivation in a flipped-classroom approach

• Published: 04 July 2024

Cite this article

• Raymond Kwong   ORCID: orcid.org/0000-0002-1401-7116 1 ,
• Man Lung Jonathan Kwok   ORCID: orcid.org/0000-0001-6069-4778 2 &
• Helen Wong   ORCID: orcid.org/0000-0001-9940-4248 2  

Drawing on self-determination theory, this study investigated the impact of different teaching styles (i.e., autonomous and controlled motivation) to motivate students to complete the pre-class activities in a flipped classroom context on their academic performance, especially in the cognitive domain of Bloom’s taxonomy. Utilizing ordinary least squares (OLS) regression analysis and a two-sample t-test, a quasi-experimental design comprising of 95 students from a higher education institution in Hong Kong was employed. The results found that among students in the class with controlled motivation from the instructors, there was a negative relationship between watching pre-recorded videos and performance on questions related to the knowledge and comprehension levels in the final examination. This negative relationship highlights the core aspect of cognitive overload, suggesting that over-engagement with video content may hinder rather than help learning. However, neither the pre-recorded videos nor the online exercises correlated with performance on questions at the application level. This outcome emphasizes the need to tailor the design of flipped classroom materials to accommodate cultural learning styles and cognitive development goals, particularly in diverse educational environments. The present study contributes to the flipped classroom literature by enhancing understanding of its impact on academic performance across the knowledge, comprehension, and application levels under Bloom’s taxonomy, and suggests practical guidelines for the use of pre-recorded videos in the flipped classroom. It also highlights the intricate balance required between student engagement strategies, the cognitive demands of learning materials, and the cultural context of learners.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or Ebook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Abeysekera, L., & Dawson, P. (2015). Motivation and cognitive load in the flipped classroom: Definition, rationale and a call for research. Higher Education Research and Development, 34 , 1–14.

Article   Google Scholar  

Academy of Active Learning Arts and Sciences (2018). Updated definition of flipped learning. Retrieved from http://aalasinternational.org/updated-definition-of-flipped-learning/

Adijaya, M. A., Widiana, I. W., Agung Parwata, I., & Suwela Antara, I. (2023). Bloom’s taxonomy revision-oriented learning activities to improve procedural capabilities and learning outcomes. International Journal of Educational Methodology, 9 , 261–270.

Agbatogun, A. O. (2014). Developing learners’ second language communicative competence through active: Clickers or communicative approach? Educational Technology and Society, 17 , 257–269.

Google Scholar  

Akcayir, G., & Akcayir, M. (2018). The flipped classroom: A review of its advantages and challenges. Computers & Education, 126 , 334–345.

Albert, M., & Beatty, B. J. (2014). Flipping the classroom applications to curriculum redesign for an introduction to management course: Impact on grades. The Journal of Education for Business, 89 , 419–424.

Awidi, I. T., & Paynter, M. (2019). The impact of a flipped classroom approach on student learning experience. Computers & Education, 128 , 269–283.

Balaban, R., Gilleskie, D., & Tran, U. (2016). A quantitative evaluation of the flipped classroom in a large lecture principles of economics course. The Journal of Economic Education, 47 , 269–287.

Beattie, V., Collins, B., & McInnes, B. (1997). Deep and surface learning: A simple or simplistic dichotomy? Accounting Education, 6 , 1–12.

Bergmann, J., & Sams, A. (2014). Flipped learning: Gateway to student engagement . International Society for Technology in Education.

Bishop, J. L., & Verleger, M. (2013). The flipped classroom: A survey of the research. 120 th ASEE Annual Conference & Exposition

Blair, R. A., Caton, J. B., & Hamnvik, O. P. R. (2020). A flipped classroom in graduate medical education. The Clinical Teacher, 17 , 195–199.

Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain . David McKay.

Bunce, D. M., Flens, E. A., & Neiles, K. Y. (2010). How long can students pay attention in class? A study of student attention decline using clickers. Journal of Chemical Education, 87 (12), 1438–1443.

Bureau, J. S., Howard, J. L., Chong, J. X. Y., & Guay, F. (2021). Pathways to student motivation: A meta-analysis of antecedents of autonomous and controlled motivations. Review of Educational Research, 92 , 46–72.

Campillo-Ferrer, J. M., & Miralles-Martínez, P. (2021). Effectiveness of the flipped classroom model on students’ self-reported motivation and learning during the COVID-19 pandemic. Humanities and Social Sciences Communications, 8 , 1–9.

Campus Technology (2017). Teaching with technology survey . Retrieved from https://digital.1105media.com/CampusTech/2017/CAM_1707/SY_1707Q1_701925010.html#p=1

Clark, R. C., Nguyen, F., & Sweller, J. (2005). Efficiency in learning: Evidence-based guidelines to manage cognitive load . Pfeiffer.

Craft, E., & Linask, M. (2020). Learning effects of the flipped classroom in a principles of microeconomics course. The Journal of Economic Education, 51 , 1–18.

Damnjanovic, V., Jednak, S., & Mijatovic, I. (2015). Factors affecting the effectiveness and use of moodle: Students’ perception. Interactive Learning Environments, 23 , 496–514.

Davies, R. S., Dean, D. L., & Ball, N. (2013). Flipping the classroom and instructional technology integration in a college-level information systems spreadsheet course. Educational Technology Research and Development, 61 , 563–580.

Deci, E. L., & Ryan, R. M. (1985). The general causality orientations scale: Self-determination in personality. Journal of Research in Personality, 19 , 109–134.

Deci, E. L., & Ryan, R. M. (2002). The paradox of achievement: The harder you push, the worse it gets. In J. Aronson (Ed.), Improving academic achievement: Impact of psychological factors on education (pp. 61–87). Academic Press.

Chapter   Google Scholar  

Deng, R., & Gao, Y. (2023). Effects of embedded questions in pre-class videos on learner perceptions, video engagement, and learning performance in flipped classrooms. Active Learning in Higher Education . https://doi.org/10.1177/14697874231167098

Divjak, B., Rienties, B., Iniesto, F., Vondra, P., & Žižak, M. (2022). Flipped classrooms in higher education during the COVID-19 pandemic: Findings and future research recommendations. International Journal of Educational Technology in Higher Education, 19 (1), 1–24.

Fendos, J. (2018). US experiences with STEM education reform and implications for Asia. International Journal of Comparative Education Development, 20 , 51–66.

Fornons, V., Palau, R., & Satiago, R. (2021). Secondary school students’ perception according to their learning style of a mathematics flipped classroom. Journal of Technology and Science Education, 11 , 227–244.

Garver, M. S., & Roberts, B. A. (2013). Flipping & clicking your way to higher-order learning. Marketing Education Review, 23 , 17–22.

Geri, N., Winer, A., & Zaks, B. (2017). Challenging the six-minute myth of online video lectures: Can interactivity expand the attention span of learners? Online Journal of Applied Knowledge Management, 5 (1), 101–111.

Goh, C., Leong, C., Kasmin, K., Hii, P., & Tan, O. (2017). Students’ experiences, learning outcomes and satisfaction in e-learning. Journal of E-Learning and Knowledge Society, 13 , 117–128.

Gopalan, C., Daughrity, S., & Hackmann, E. (2022). The past, the present, and the future of flipped teaching. Advances in Physiology Education, 46 (2), 331–334.

Hackathorn, J., Garczynski, A. M., Blankmeyer, K., Tennial, R. D., & Solomon, E. D. (2011). All kidding aside: Humor increases learning at knowledge and comprehension levels. Journal of the Scholarship of Teaching and Learning, 11 , 116–123.

Hernandez-de-Menendez, M., Vallejo Guevara, A., Tudon Martinez, J. C., Hernandez Alcantara, D., & Morales-Menendez, R. (2019). Active learning in engineering education: A review of fundamentals, best practices and experiences. International Journal on Interactive Design and Manufacturing, 13 , 909–922.

Kamarainen, A. M., Metcalf, S., Grotzer, T., Browne, A., Mazzuca, D., Tutwiler, M. S., & Dede, C. (2013). EcoMOBILE: Integrating augmented reality and probeware with environmental education field trips. Computers & Education, 68 , 545–556.

Kang, S. H. (2016). Spaced repetition promotes efficient and effective learning: Policy implications for instruction. Policy Insights from the Behavioral and Brain Sciences, 3 , 12–19.

Karabatak, S., & Polat, H. (2020). The effects of the flipped classroom model designed according to the ARCS motivation strategies on the students’ motivation and academic achievement levels. Education and Information Technologies, 25 , 1475–1495.

Kember, D. (2009). Promoting student-centred forms of learning across an entire university. Higher Education, 58 , 1–13.

Kim, M. K., Kim, S. M., Khera, O., & Getman, J. (2014). The experience of three flipped classrooms in an urban university: An exploration of design principles. Internet and Higher Education, 22 , 37–50.

Krathwohl, D. R. (2002). A revision of bloom’s taxonomy: An overview. Theory into Practice, 41 , 212–218.

Lai, C.-L., & Hwang, G.-J. (2016). A self-regulated flipped classroom approach to improving students’ learning performance in a mathematics course. Computers and Education, 100 , 126–140.

Li, R., Lund, A., & Nordsteien, A. (2023). The link between flipped and active learning: A scoping review. Teaching in Higher Education, 28 , 1993–2027.

Liu, C. K. W. (2019). A holistic approach to flipped classroom: A conceptual framework using e-platform. International Journal of Engineering Business Management, 11 , 1–9.

Liu, X. X., Gong, S. Y., Zhang, H. P., Yu, Q. L., & Zhou, Z. J. (2021). Perceived teacher support and creative and creative self-efficacy: The mediating roles of autonomous motivation and achievement emotions in Chinese junior high school students. Thinking Skills and Creativity, 39 , 100752.

Lopes, A. P., & Soares, F. (2018). Perception and performance in a flipped financial mathematics classrooms. The International Journal of Management Education, 16 , 105–113.

Lord, T., & Baviskar, S. (2007). Moving students from information recitation to information understanding: Exploiting Bloom’s Taxonomy in creating science questions. Journal of College Science Teaching, 36 , 40–44.

Manganelli, S., Cavicchiolo, E., Mallia, L., Biasi, V., Lucidi, F., & Alivernini, F. (2019). The interplay between self-determined motivation, self-regulated cognitive strategies, and prior achievement in predicting academic performance. Educational Psychology, 39 , 470–488.

Nentl, N., & Zietlow, R. (2008). Using Bloom’s taxonomy to teach critical thinking skills to business students. College & Undergraduate Libraries, 15 , 159–172.

Ng, P. M. L., Chan, J. K. Y., Wut, T. M., Lo, M. F., & Szeto, I. (2021). What makes better career opportunities for young graduates? Examining acquired employability skills in higher education institutions. Education + Training, 63 , 852–871.

Ng, P., & Galbraith, C. (2016). Strategic enrolment management (SEM) in self-financed higher education of Hong Kong: Evaluation and measurement. Asia Pacific Education Review, 17 , 161–174.

O’Flaherty, J., & Phillips, C. (2015). The use of flipped classrooms in higher education: A coping review. The Internet and Higher Education, 25 , 85–95.

Oxford, R., & Anderson, N. (1995). A cross-cultural view on learning styles. Language Teaching, 28 , 201–215.

Prince, M. (2004). Does active learning work? A review of the research. Journal of Engineering Education, 93 , 223–231.

Psihountas, D. (2018). Flipped classrooms and finance – Is this a better way to learn? Journal of Financial Education, 44 , 1–11.

Qureshi, M. A., Khaskheli, A., Qureshi, J. A., Raza, S. A., & Yousufi, S. Q. (2023). Factors affecting students’ learning performance through collaborative learning and engagement. Interactive Learning Environments, 31 , 2371–2391.

Rivera, E. (2015). Using the flipped classroom model in your library instruction course. The Reference Librarian, 56 , 34–41.

Roger, J., & Revesz, A. (2019). Experimental and quasi-experimental designs. The Routledge handbook of research methods in applied linguistics (pp. 133–143). Routledge.

Rothman, S. B. (2022). An examination of student preferences and learning outcomes in flipped classroom with online videos. Journal of Political Science Education, 18 , 605–613.

Ryan, R. M., & Deci, E. L. (2002). An overview of self-determination theory: An organismic-dialectical perspective. In E. L. Deci & R. M. Ryan (Eds.), Handbook of self-determination research (pp. 3–36). The University of Rochester Press.

Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Education Psychology, 61 , 101860.

Senali, M. G., Iranmanesh, M., Ghobakhloo, M., Gengatharen, D., Tseng, M. L., & Nilsashi, M. (2022). Flipped classroom in business and entrepreneurship education: A systematic review and future research agenda. The International Journal of Management Education, 20 , 100614.

Shehata, B., Tlili, A., Huang, R., Adarkwah, M. A., Liu, M., & Chang, T. (2023). How are we doing with student-centered learning facilitated by educational technologies? A systematic review of literature reviews. Education and Information Technologies, 1–42.

Sivrikaya, A. H. (2019). The relationship between academic motivation and academic achievement of the students. Asian Journal of Education and Training, 5 , 309–315.

Sohrabi, B., & Iraj, H. (2016). Implementing flipped classroom using digital media: A comparison of two demographically different groups’ perceptions. Computers in Human Behavior, 60 , 514–524.

Sosa Diaz, M. J., Guerra Antequera, J., & Cerezo Pizarro, M. (2021). Flipped classroom in the context of higher education: Learning, satisfaction and interaction. Education Sciences, 11 , 416.

Strelan, P., Osborn, A., & Palmer, E. (2020). The flipped classroom: A meta-analysis of effects on student performance across disciplines and education levels. Educational Research Review, 30 , 100314.

Sun, J. C. Y., & Wu, Y. T. (2016). Analysis of learning achievement and teacher-student interactions in flipped and conventional classrooms. International Review of Research in Open and Distributed Learning, 17 , 79–99.

Takele, S. (2017). Validity strength of college entrance assessment score and high school academic records in predicting college academic performance. Journal of Education and Practice, 8 (7), 67–75.

Teo, T. W., Tan, K. C. D., Yan, Y. K., Teo, Y. C., & Yeo, L. W. (2014). How flip teaching supports undergraduate chemistry laboratory learning. Chemistry Education Research and Practice, 15 , 550–567.

Vansteenkiste, M., Sierens, E., Soenens, B., Luyckx, K., & Lens, W. (2009). Motivational profiles from a self-determination perspective: The quality of motivation matters. Journal of Educational Psychology, 101 , 671–688.

Wan, Y. (2021). Why are they so quiet? Exploring reticent and passive East Asian ESL students in the US classrooms. Open Journal of Modern Linguistics, 11 (6), 942–954.

Wei, X., Cheng, I. L., Chen, N. S., Yang, X., Liu, Y., Dong, Y., Zhai, X., & Kinshuk. (2020). Effect of the flipped classroom on the mathematics performance of middle school students. Educational Technology Research and Development, 68 , 1461–1484.

Wei, H. C., & Chou, C. (2020). Online learning performance and satisfaction: Do perceptions and readiness matter? Distance Education, 41 , 48–69.

Wilson, K., & Korn, J. H. (2007). Attention during lectures: Beyond ten minutes. Teaching of Psychology, 34 (2), 85–89.

Wong, P., Ng, P. M. L., Mak, C. K., & Chan, J. K. (2016). Students’ choice of sub-degree programmes in self-financing higher education institutions in Hong Kong. Higher Education, 71 , 455–472.

Yang, D. (2017). Instructional strategies and course design for teaching statistics online: Perspectives from online students. International Journal of STEM Education, 4 , 1–15.

Zainuddin, Z., & Attaran, M. (2015). Malaysian students’ perceptions of flipped classroom: A case study. Innovations in Educations in Education and Teaching International, 53 , 660–670.

Download references

Author information

Authors and affiliations.

Department of Social Sciences, School of Arts and Social Sciences, Hong Kong Metropolitan University, Kowloon, Hong Kong

Raymond Kwong

College of Professional and Continuing Education, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

Man Lung Jonathan Kwok & Helen Wong

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Raymond Kwong .

Ethics declarations

Conflict of interest, ethical approval.

The present study involved the students to complete the online survey and the ethics approval has been sought by the CPCE Research Office (CRO, College of Professional and Continuing Education Research Office, The Hong Kong Polytechnic University), with the reference no. EC04.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Kwong, R., Kwok, M.L.J. & Wong, H. Autonomous and controlled motivation in a flipped-classroom approach. Asia Pacific Educ. Rev. (2024). https://doi.org/10.1007/s12564-024-09983-0

Download citation

Received : 11 June 2023

Revised : 13 March 2024

Accepted : 25 June 2024

Published : 04 July 2024

DOI : https://doi.org/10.1007/s12564-024-09983-0

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Flipped classroom
• Bloom’s taxonomy
• Academic performance
• Autonomous motivation
• Controlled motivation
• Find a journal
• Publish with us
• Track your research

A Critical Literature Review of Studies in Teaching and Learning

• 2(4):268-271

• Wachemo University

Discover the world's research

• 25+ million members
• 160+ million publication pages
• 2.3+ billion citations

• Salam Abbas

• Quanyou Zhang
• Qiongjie Kou
• Alenoush Saroyan
• Cheryl Amundsen

• Aga Khan Foundation
• Amare Asgedom
• Daniel Desta
• Alison Price-Rom

• Abel G.M. Ishumi

• Recruit researchers
• Join for free
• Login Email Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google Welcome back! Please log in. Email · Hint Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google No account? Sign up

• Open access
• Published: 03 July 2024

Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies

• Samantha Spanos   ORCID: orcid.org/0000-0003-3734-3907 1 ,
• Elle Leask   ORCID: orcid.org/0000-0003-1698-9151 1 ,
• Romika Patel   ORCID: orcid.org/0009-0000-6523-8798 1 ,
• Michael Datyner 1 ,
• Erwin Loh   ORCID: orcid.org/0000-0001-7157-0826 2 &
• Jeffrey Braithwaite   ORCID: orcid.org/0000-0003-0296-4957 1  

BMC Medical Education volume  24 , Article number:  720 ( 2024 ) Cite this article

Metrics details

As healthcare systems rapidly become more complex, healthcare leaders are navigating expanding role scopes and increasingly varied tasks to ensure the provision of high-quality patient care. Despite a range of leadership theories, models, and training curricula to guide leadership development, the roles and competencies required by leaders in the context of emerging healthcare challenges (e.g., disruptive technologies, ageing populations, and burnt-out workforces) have not been sufficiently well conceptualized. This scoping review aimed to examine these roles and competencies through a deep dive into the contemporary academic and targeted gray literature on future trends in healthcare leadership roles and competencies.

Three electronic databases (Business Source Premier, Medline, and Embase) were searched from January 2018 to February 2023 for peer-reviewed literature on key future trends in leadership roles and competencies. Websites of reputable healthcare- and leadership-focused organizations were also searched. Data were analyzed using descriptive statistics and thematic analysis to explore both the range and depth of literature and the key concepts underlying leadership roles and competencies.

From an initial 348 articles identified in the literature and screened for relevance, 39 articles were included in data synthesis. Future leadership roles and competencies were related to four key themes: innovation and adaptation (e.g., flexibility and vision setting), collaboration and communication (e.g., relationship and trust building), self-development and self-awareness (e.g., experiential learning and self-examination), and consumer and community focus (e.g., public health messaging). In each of these areas, a broad range of strategies and approaches contributed to effective leadership under conditions of growing complexity, and a diverse array of contexts and situations for which these roles and competencies are applicable.

Conclusions

This research highlights the inherent interdependence of leadership requirements and health system complexity. Rather than as sets of roles and competencies, effective healthcare leadership might be better conceptualized as a set of broad goals to pursue that include fostering collaboration amongst stakeholders, building cultures of capacity, and continuously innovating for improved quality of care.

Peer Review reports

Healthcare leadership has grown in scope and importance in response to the increasing complexity of healthcare delivery [ 1 ]. Healthcare systems have become increasingly multifaceted, delivering a vast array of services across multiple levels, from preventative and primary care to acute, specialized care, and long-term care, to address the care needs of a changing population [ 1 ]. As populations age, chronic diseases rise, and the epidemiology and demographics of disease shift, new models of care rapidly emerge to address the ever-expanding spectrum of patient needs [ 2 ]. Advancements in technologies, tests and treatments and personalized medicine come with regulatory and ethical implications, and a growth in workforce specializations [ 3 , 4 ]. Healthcare leaders are navigating evermore complex webs of actors in the system – doctors, nurses, technicians, administrators, insurers, and patients – striving to balance priorities, foster collaboration, and provide strategic direction toward high-quality and safe patient care [ 5 ]. At the same time as running complex services, healthcare leaders need to continually assess, implement, and govern new technologies and services, adhere to the latest regulations and guidelines, operate within the confines of budgetary allocations, and meet growing consumer expectations for affordable and accessible care [ 6 , 7 ].

Competent healthcare leadership is widely considered to be critical for improving patient safety, system performance, and the effectiveness of healthcare teams [ 8 , 9 , 10 ]. Leadership has been identified as a key shaping influence on organizational culture [ 11 ], including workplace commitment to safety [ 12 ], and on preventing workforce burnout [ 13 , 14 ]. The increased need for multidisciplinary and integrated care models has shed growing light on the leadership roles of clinicians, including physicians, nurses, and allied health practitioners [ 15 , 16 , 17 ]. Individuals with both clinical and leadership expertise have been considered vital in complex healthcare landscapes because of their ability to balance administrative needs while prioritizing safety and high-quality care provision [ 18 , 19 , 20 , 21 , 22 ]. For example, physician leaders, through their deep understanding of clinical care and their credibility and influence, have been considered best able to devise strategies that improve patient care amidst stringent financial conditions [ 23 , 24 , 25 , 26 ]. Clinical leaders, particularly physician leaders, might also be of key importance for facilitating the success of collaborative care and care integration [ 27 ].

The formalization of healthcare leadership emerged as the importance of specialized healthcare leadership skills became increasingly needed, recognized and understood [ 1 , 28 , 29 ]. Leadership in healthcare has been conceptualized in several different ways, and a multitude of theories, frameworks, and models have been proposed to explain leadership roles and responsibilities [ 30 , 31 , 32 , 33 ]. For example, the CanMEDS Framework describes the Leader Role of physicians, which is comprised of key and enabling competencies, tasks, and abilities [ 34 , 35 ], and adaptations to this Framework emphasize the varying roles that leadership comprises and the competencies that fulfill them [ 36 ]. Although these frameworks present a good starting point for articulating leadership role scopes and their associated competencies, many fall short in explaining how leaders navigate complex, dynamic, multi-dimensional, and highly variable healthcare systems [ 37 ]. This is becoming increasingly recognized; CanMEDS is due to be updated in 2025 to incorporate competencies related to complexity [ 38 ]. Meanwhile, on the front lines, lack of role clarity and ambiguity about tasks and responsibilities presents a significant barrier for healthcare leaders [ 1 , 15 ]. In complex and unpredictable systems like healthcare, leaders spend substantial time ‘sense-making’, understanding, prioritizing and responding adaptively according to the needs of the situation [ 39 , 40 ]. The latest research on future healthcare trends tells us that increasing complexity associated with digital innovation, healthcare costs, regulatory compliance, sustainability concerns and equitable resource distribution will pose challenges to all actors in health systems [ 41 , 42 , 43 , 44 , 45 ]. In the face of these emerging challenges, it is vital to understand the range and type of roles and competencies that leaders will need to fulfil in the imminent future.

The aim of this scoping review is to examine the literature on the key trends in roles and competencies required for healthcare leaders in the future. We conceptualized ‘competencies’ as the attributes, skills, and abilities that comprise the fulfilment of varying leadership roles, as informed by the CanMEDS Framework [ 34 , 36 ]. Scoping review methodology was utilized to capture a broad range of literature types and identify key themes or groupings of future trends in leadership roles and competencies. Rather than focusing on answering specific questions (as per previous systematic reviews on leadership [ 46 , 47 ]) or developing theory (by utilizing a theoretical review approach to leadership literature [ 48 , 49 ]), we sought to map and identify patterns and trends within the leadership literature [ 50 ]. To investigate trends in leadership roles and competencies, we targeted emerging perspectives from key reputable thought leaders to supplement academic research [ 51 , 52 ].

The conduct and reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [ 53 ].

Search strategy

Comprehensive search strategies were developed, adapting search strategies utilized in a previous systematic review on physician leadership [ 26 ], and receiving input and expertise from two clinical librarians at Macquarie University (see supplementary file 1 for database search strategies). Medline, Embase, and Business Source Premier were searched from January 2018 to February 2023 to enable meaningful inferences to be made about future trends based on current perspectives. To capture key trends, patterns, shifts, and forecast changes to healthcare leadership, the Medline database search was limited to the ‘Trends’ subheading, “ used for the manner in which a subject changes, qualitatively or quantitatively, with time, whether past, present, or future. Includes “forecasting” & “futurology" ” (see supplementary file 1 ) [ 54 ]. For Embase and Business Source Premier, the ‘Trends’ subheading was not available, and instead key search terms were included to capture future trends, including “predict*”, “forecast*”, “shift*” and “transform*”. Efforts were made to locate texts that could not be retrieved, by searching Macquarie University’s digital library records and contacting authors to request the full text.

To complement the database searches, targeted searches of the Faculty of Medical Leadership and Management (FMLM; UK) website and The King’s Fund (UK) website were undertaken to identify emerging perspectives on the future roles and requirements of healthcare leaders. Targeted website searches can aid in uncovering unpublished yet relevant research identified by advocacy organizations or subject specialists, and research potentially missed by database searches [ 52 , 55 ]. Key search terms entered into the websites included ‘future healthcare’, ‘medical leader’, ‘clinical leader’, ‘medical manager’, ‘physician executive’, and ‘education and training’. We included articles that focused on leaders with a clinical background and leaders without a clinical background, to provide a comprehensive overview of leadership roles and requirements of reference to health systems [ 26 ].

Article selection

Database literature search.

References were uploaded into online data management software Rayyan [ 56 ], and duplicate records were identified and removed. Titles and abstracts of results were screened by three team members (SS, EL, RP) according to the inclusion and exclusion criteria (Table  1 ). Articles were included if they focused on future trends in the roles, competencies, attributes, or requirements of healthcare leaders, and if they reported on countries within the Organization for Economic Co-operation and Development (OECD). We limited our search to OECD countries to maximize the generalizability of findings within a developed context and enable meaningful trends to be identified. A subset of the articles was screened by all three team members to ensure that decisions were being made in a standardized manner. After this article subset was screened, the three team members discussed screening decisions, and disagreements were resolved by consensus or through discussion with JB [ 57 ]. During this process, two further exclusion criteria (#4 and #5, Table  1 ) were added to ensure that the screening process adhered to the aim of the current review. We excluded articles that focused on theories and definitions of leadership (e.g., for the purpose of developing educational or professional frameworks) without highlighting trends or changes in roles and competencies for future leadership. We also excluded articles that focused on healthcare interventions in which leaders may have been participants, but their roles or competencies were not the focus. Articles included at title and abstract screening were independently read in full and assessed for eligibility. Disagreements about inclusion were resolved through discussion, with JB available for arbitration if necessary. It was determined at this stage that if articles were conference abstracts in which the full presentation could not be accessed, the article of focus was sought and included in the analysis.

Targeted gray literature search

References were screened according to the inclusion and exclusion criteria (Table  1 ), except that articles only needed to report (rather than focus) on future leadership roles and requirements. This is because we wanted to ensure that our analysis broadly captured the most recent sources of information on healthcare leadership requirements, even if these sources did not focus exclusively on leadership.

Data charting process

Data from all records were appraised and charted simultaneously using a purpose-designed Excel data charting form designed by SS (and subsequently reviewed and endorsed by RP and EL). Multimedia records arising from targeted gray literature searches were listened to and transcribed by RP and checked by SS. Extracted data included article details (authors, year, country, text type), leadership focus (training or educational approaches, styles of leadership), and major and minor themes. Database literature were extracted first to identify and develop themes, and the targeted gray literature were extracted second to extend and embellish those themes.

Synthesis of results

Data from included articles were synthesized according to the Arksey and O’Malley framework for scoping reviews, selected for its detailed guidance on data collation, synthesis, and presentation [ 58 ]. The breadth, range, and type of data were analyzed using descriptive statistics, and underlying groups of leadership roles and competencies were analyzed using thematic analysis. First, the authorship team familiarized themselves with the articles to gain a broad overview of contexts in which leadership was discussed. An inductive approach was used to identify emerging themes of leadership roles and competencies in the database literature, where common concepts were identified, coded, and grouped together to form themes. Team discussion facilitated the final set of themes that were interpreted from the data. During this process, the extracted data were compared to the codes, groups, and resultant themes to examine the degree of consistency between the data and the interpreted findings. Where inconsistencies were identified, suggested changes (e.g., to code labels or groupings) were compared, and the most appropriate changes adopted. Targeted gray literature sources were deductively analyzed according to the identified themes.

Selection of sources of evidence

Figure  1 displays the process of identification and screening of included studies. Database searches yielded 160 records, from which 11 duplicates were removed. The remaining 149 database records were screened by title and abstract, after which a further 114 records were excluded. Of the remaining 35 that were assessed for eligibility, 22 were excluded, and 13 were included in the current review. Targeted gray literature searches yielded an additional 188 records, from which 146 were identified as duplicates and removed. The remaining 42 records were read in full and assessed for eligibility, from which a further 16 were excluded, and 26 were included in the current review. In total, 39 records were retained and synthesized.

PRISMA flowchart displaying the process of identification and selection of included articles

Characteristics of sources of evidence

The characteristics of the included records are displayed in Tables  2 and 3 . Of the database literature, most articles were published in the USA ( n  = 11), and the remaining two articles were published in Canada and Australia. Seven articles were empirical; three studies employed qualitative methods [ 59 , 60 , 61 ], three were quantitative [ 62 , 63 , 64 ], and one mixed methods [ 65 ]. Six articles were non-empirical; three were perspective pieces [ 66 , 67 , 68 ], and three were reports on training or organizational interventions [ 69 , 70 , 71 ]. Of the targeted literature, blog-type articles were most common ( n  = 11) [ 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ], followed by news articles ( n  = 5) [ 83 , 84 , 85 , 86 , 87 ], reports ( n  = 4) [ 88 , 89 , 90 , 91 ], editorials ( n  = 2) [ 92 , 93 ], podcasts ( n  = 2) [ 94 , 95 ], and video and interview transcripts ( n  = 2) [ 96 , 97 ]. As targeted gray sources selected were The King’s Fund website and the FMLM website, the records from these websites were published in the UK.

Leadership roles and competencies

All 13 articles derived from the database searches focused on innovation and adaptation in future leadership. Two empirical articles reported on the ways in which clinical and non-clinical leaders innovated during the COVID-19 pandemic, rapidly designing new models of hospital care [ 61 ] and extending their roles to encompass the implementation of virtual leadership [ 64 ]. Qualitative investigations explored the importance of entrepreneurial leadership for implementing clinical genomics [ 59 ] and key leadership attributes for practice-level innovation and sustainability [ 60 ]. Four articles examined leadership training approaches that build physicians’ capacity to understand, adapt to, and manage change, overcome resistance, and think entrepreneurially [ 62 , 63 , 65 , 70 ]. Two reports described the necessity for healthcare leaders to be able to create a shared vision for an organization; one highlighted the importance of leaders being confident and “self-propelled to intervene” [ 69 ], and one emphasized physician leaders’ credibility as a catalyst for change management among healthcare providers [ 71 ]. The latter report also identified that visible and committed leadership that is sensitive to workplace cultures is critical for the success of change management activities [ 71 ]. Three perspective pieces discussed increasing opportunities for medical and other clinical leaders to create positive change in increasingly complex healthcare landscapes and fulfill the demands of the industry and public [ 66 , 67 , 68 ].

In the targeted gray literature, 19 of 26 records (73%) focused on innovative and adaptive leadership. Records primarily explored adaptive leadership behaviors during COVID-19, such as service redesign, introducing improved flexibility, learning mechanisms, and support platforms [ 73 , 76 , 77 , 97 ], and future innovation to manage climate change impacts [ 81 ], growing inequities [ 89 ], and emerging technologies [ 75 , 83 , 94 , 96 ]. Comfort with change, vision setting, and a desire to innovate were emphasized as key leadership attributes for future healthcare [ 82 , 83 , 88 , 96 ]. Records also explored how to best train and develop leaders for transforming health systems, including the National Health Service (NHS) [ 84 , 90 , 96 ]. New leadership training structures were proposed that foster innovation and adaptability in leaders [ 80 , 90 , 96 ] and encourage flexibility for cross-disciplinary learning.

Collaboration and communication  was a second theme that emerged across all 13 database articles. Three studies explored how collaborative leadership can foster innovation with regards to implementing genomics testing [ 59 ], creating new work models during COVID-19 [ 61 ] and developing new leadership styles via telecommunications [ 64 ]. Six articles focused on the importance of collaborating to build relationships across organisations [ 67 , 68 , 71 ] and within teams [ 65 , 69 , 70 ]. Three articles highlighted that effective communication contributes to organizational success, through fostering psychologically safe cultures [ 60 , 66 ] and generating the trust and rapport necessary for implementing technological innovations [ 71 ]. Two studies examined the impact of leadership training on physicians’ communication competencies [ 62 , 63 ].

In the targeted gray literature, 17 of 26 records (65%) focused on collaboration and communication. Records discussed specific initiatives to improve communication in clinical teams, such as staff surveys, daily huddles, and dedicated days for networking [ 75 , 77 , 80 , 95 ]. Cross-boundary collaboration and collective leadership (e.g., between clinicians and managers) [ 83 ] were advocated as a means to solve challenges [ 81 , 90 ], help build public trust [ 79 , 83 ], and improve quality of care [ 78 , 83 , 85 , 94 ]. Twelve records focused on the importance of team and leadership collaboration to create positive workplace cultures and improve staff wellbeing, through communication strategies such as openness and honesty [ 78 , 80 , 95 ], active listening and empathy [ 73 , 78 , 86 , 88 , 90 ], transparency [ 88 , 94 , 95 ], and inclusivity [ 85 , 94 ]. Three articles emphasized that encouraging staff autonomy, building trust, and demonstrating compassion facilitate better quality care than demanding and punitive leadership actions [ 73 , 74 , 88 ].

Nine of 13 database articles (69%) focused on a third theme, self-development and self-awareness in leadership. Four articles examined approaches to leadership development that incorporated self-development and self-awareness (e.g., personality testing) [ 63 , 65 , 69 , 70 ], with two articles describing these competencies as enablers for the development of other more advanced competencies (e.g., execution) [ 69 , 70 ]. Similar competencies explored included landscape awareness [ 60 ], self-organisation [ 60 ], emotional intelligence [ 64 ], and self-examination, the last of which was described as essential to gain skills beyond clinical roles [ 68 ], facilitate positive perceptions of others [ 66 ], and to remain relevant and effective in a changing healthcare environment [ 67 ]. One article also proposed strategies such as journaling, mindfulness, and feedback to encourage ongoing reflection on leadership decisions and biases [ 67 ].

In the targeted gray literature, seven of 26 records (27%) focused on self-development and self-awareness. Records examinedd the importance of continual personal leadership development, including mentoring and experiential learning, to facilitate understanding of one’s own skills [ 78 , 80 , 97 ]. Tools to facilitate self-reflection in physician leaders were advocated including the FMLM smartphone app [ 92 ] and leadership longitudinal assessments [ 91 ]. Self-care and resilience practices (e.g., meditation, social support) were also advocated for physician leaders as a means to manage “greater levels of stress and responsibility” [ 94 ].

Consumer engagement and advocacy  was a fourth theme and a focus of nine targeted gray literature records (35%). Records discussed patient and community engagement as essential for health system improvement, and examples included involving patients in health service design [ 74 , 77 ], creating channels of ongoing dialogue [ 79 , 83 ] and building stronger health system-community relationships [ 79 , 88 ]. Two records described the importance of public health messaging in improving health literacy [ 83 ] and countering misinformation [ 86 ], and two focused on the role of leaders in advocating for social justice and striving to improve equitable outcomes [ 75 , 93 ].

This scoping review identified 39 key resources that explored future trends in healthcare leadership roles and competencies. These records were derived from a combination of academic and targeted gray literature searches, juxtaposed and synthesized to build understanding of leadership to improve health systems into the future. Four themes of competencies emerged from the findings – innovation and adaptation, communication and collaboration, self-development and self-awareness, and consumer engagement and advocacy.

The competencies of healthcare leaders given the most attention in the literature over the last five years relate to innovation and adaptability . Both the academic and targeted gray literature focused on how leaders, clinical and non-clinical, demonstrated innovativeness and adapted to the demands of COVID-19, including rethinking and redesigning systems to support staff and patients [ 64 , 77 ]. The second focus of the literature on innovation and adaptability was geared toward the development of these capacities in leaders through education and training, as well as through opportunities for leaders to actualize their skills [ 70 , 90 ]. The literature indicated that as the complexity of healthcare is accelerating, leaders must both understand, and have opportunities to demonstrate, innovation amidst dynamic, variable, and demanding environments [ 59 , 60 , 71 ]. This aligns with prior research demonstrating that innovation uptake requires strong change management, and the ability to rapidly assess, understand, and apply innovative changes (e.g., medical technologies) [ 1 , 98 ]. While innovations might improve the system’s ability to deal with complex challenges in the long-term, their implementation can be challenged by a number of moving parts – including workforce changes, new rules and regulations, fluctuating resources and new patient groups – which leaders must consider and appropriately plan for [ 99 , 100 ]. Perhaps an even greater challenge for leaders to overcome when embracing innovation is the tendency for growing complexity to lock the organization into suboptimal conditions (i.e., inertia) [ 101 ]. Building awareness of the interacting components of complex systems and the flexibility required for adaptation and resilience should be a key focus of healthcare leadership education and training [ 102 ].

Competencies associated with communication and collaboration have also been a focus of the healthcare leadership literature. Academic literature dealt primarily with how collaborative structures and behaviors can help leaders innovate and build organizational cultures geared for success [ 59 , 61 , 71 ]. Targeted gray literature focused on how leaders can foster communication within teams, and the positive impacts of an open and accountable culture on staff wellbeing and productivity [ 73 , 74 ]. These findings echo research on resilient health systems emphasizing that ‘over-managing’ restricts the adaptive capacities needed by teams within dynamic healthcare environments [ 100 , 103 ]. The literature pointed to the need for leaders to strengthen communication and collaboration at varying levels – environmental, team, and organizational – to enable more efficient and better-quality healthcare delivery, and during this process they should endeavor to model the balance between autonomy and accountability [ 104 ]. Implementing regular touchpoints that engage multiple stakeholders, such as communities of practice, can help to create positive feedback loops that enable systems change [ 105 ], and overcome organizational barriers to collaboration and information sharing, such as weak relationships and inadequate communication [ 106 , 107 ].

Self-development and self-awareness  also emerged as an important aspect of leadership. Academic literature focused primarily on how these capacities are developed in leaders through structured education and training, including self-assessments and targeted educational modules [ 65 , 69 ]. Targeted gray literature discussed a range of activities outside of structured training (e.g., experiential learning) that can support leaders’ self-reflection and development, for physician leaders in particular to assess their performance and improve their leadership approaches [ 91 , 92 ]. These findings suggest that personal leadership development must go beyond formal curriculum requirements to incorporate everyday learning inputs [ 78 ], and align with other recent literature suggesting that self-regulation in leaders can be fostered through practicing self-discipline, boundary-setting, and managing disruptions, particularly in the digital age [ 108 , 109 ]. Practicing self-awareness can help leaders not only to sense-make in complex systems – to adapt to new situations and make appropriate trade-offs – but also to sense-give – to articulate and express the organization’s vision [ 40 ]. A minor theme, observed only in the targeted gray literature, was related to leaders’ roles and competencies in consumer engagement and advocacy . The importance of increasing consumer engagement in healthcare was emphasized, as well as the structures that are needed to facilitate these changes [ 79 ]. Working alongside consumers was highlighted as critical during times of changing care and need, such as during COVID-19 [ 77 , 86 ]. Although the involvement of consumers and the public in the co-production of care is increasing [ 110 ], there is limited academic literature focused on the roles of leaders in creating optimal environments for co-production. Consumer and community involvement in change efforts helps to improve care processes and outcomes [ 111 ], but leaders might face challenges understanding and operationalizing local engagement mechanisms [ 112 ]. Identifying the organizational and system levers that enable greater consumer involvement, and how leaders can advocate for these levers in their local context, is a fruitful area for future investigation.

The findings of the current review have implications for professional organizations that train healthcare leaders, such as the Australian College of Health Services Management (ACHSM) in Australia, and train clinicians to be leaders, including the UK’s FMLM. Creating a future-focused curriculum addressing the competencies related to the themes identified, in particular innovation and adaptability, is essential to prepare healthcare leaders for growing and changing scopes of responsibility. Such competencies are less amenable to formal theoretical teaching solely and require carefully crafted experiential learning programs in health settings, with supervision by experienced and effective healthcare leaders.

Strengths and limitations

A notable strength of this scoping review was the inclusion of a broad range of sources and perspectives on the future of healthcare leadership. We captured empirical studies, theoretical academic contributions (e.g., commentaries from healthcare leaders), and targeted grey literature, which is often a more useful source of information on emerging topics [ 52 ]. As a result, our findings identified key future trends in the roles and competencies of leaders, both clinical and non-clinical, across a wide range of contexts and situations. Another strength of this review was its specific focus on contemporary literature that examined future trends in leadership, to inform how leaders can prepare for upcoming challenges, rather than focusing on leadership that was effective in the past.

There are limitations to this review. Our search strategies may not have adequately captured other leadership trends applicable across contemporary healthcare settings or those faced by leaders and teams on the front lines of care [ 113 ]. Incorporating search terms related to specific settings, as well as complex systems concepts, may have enabled greater inferences to be made about how unique future challenges require new approaches to the development of healthcare leaders. To scope future-focused research and perspectives, database searches were narrowly restricted, and it is likely that key articles were missed. Targeted gray literature searches represent key thought leaders in healthcare and leadership, and while this enabled relevant information to be efficiently collected, undertaking highly focused searches may have introduced bias associated with geographical area (i.e., the UK) and particular stakeholder groups (e.g., policy-makers) [ 55 ]. Our choice to limit the current review to studies reporting in OECD countries further limited generalizability to other settings including in low-income and middle-income countries (LMICs) [ 1 ].

The roles and competencies of leaders are deeply enmeshed in, and reflective of, a complex and continuously transforming healthcare system. This research highlights the types of roles and competencies important for leaders facing a myriad of challenges, and the range of contexts and situations in which these types of roles and competencies can be applied. The ways in which roles and competencies manifest is highly contextual, dependent on both role responsibilities and the situational demands of healthcare environments.

Data availability

Data supporting these research findings are available upon reasonable request. Further inquiries can be directed to the corresponding author.

Abbreviations

Faculty of Medical Leadership and Management

National Health Service

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews

Royal Australasian College of Medical Administrators

United States of America

United Kingdom

Figueroa CA, Harrison R, Chauhan A, et al. Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Serv Res. 2019;19:1–11. https://doi.org/10.1186/s12913-019-4080-7

Article   Google Scholar  

Braithwaite J, Mannion R, Matsuyama Y, et al. The future of health systems to 2030: a roadmap for global progress and sustainability. Int J Qual Health Care. 2018;30(10):823–31. https://doi.org/10.1093/intqhc/mzy242

Anklam E, Bahl MI, Ball R, et al. Emerging technologies and their impact on regulatory science. Exp Biol Med. 2022;247(1):1–75. https://doi.org/10.1177/15353702211052280

Maeda A, Socha-Dietrich K. Skills for the future health workforce: preparing health professionals for people-centred care. OECD Health Working Papers. Paris: OECD Publishing,; 2021.

Reich MR, Javadi D, Ghaffar A. Introduction to the special issue on effective leadership for health systems. Health Syst Reform. 2016;2(3):171–5. https://doi.org/10.1080/23288604.2016.1223978

Shaw J, Brewer LC, Veinot T. Recommendations for health equity and virtual care arising from the COVID-19 pandemic: narrative review. JMIR Form Res. 2021;5(4):e23233. https://doi.org/10.2196/23233

Graham R, Woodhead T. Leadership for continuous improvement in healthcare during the time of COVID-19. Clin Radiol. 2021;76(1):67–72. https://doi.org/10.1016/j.crad.2020.08.008

Parr JM, Teo S, Koziol-McLain J. A quest for quality care: exploration of a model of leadership relationships, work engagement, and patient outcomes. J Adv Nurs. 2021;77(1):207–20. https://doi.org/10.1111/jan.14583

Ree E, Wiig S. Linking transformational leadership, patient safety culture and work engagement in home care services. Nurs Open. 2020;7(1):256–64. https://doi.org/10.1002/nop2.386

Wu X, Hayter M, Lee AJ, et al. Positive spiritual climate supports transformational leadership as means to reduce nursing burnout and intent to leave. J Nurs Manag. 2020;28(4):804–13. https://doi.org/10.1111/jonm.12994

West M, Armit K, Loewenthal L, et al. Leadership and leadership development in health care: the evidence base. London: The King’s Fund; 2015.

Google Scholar  

Churruca K, Ellis LA, Pomare C, et al. Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. BMJ Open. 2021;11(7):e043982. https://doi.org/10.1136/bmjopen-2020-043982

Smallwood N, Bismark M, Willis K. Burn-out in the health workforce during the COVID-19 pandemic: opportunities for workplace and leadership approaches to improve well-being. BMJ Lead. 2023;leader–2022. https://doi.org/10.1136/leader-2022-000687

Kelly RJ, Hearld LR. Burnout and leadership style in behavioral health care: a literature review. J Behav Health Serv Res. 2020;47(4):581–600. https://doi.org/10.1007/s11414-019-09679-z

Hutchinson K, Ryder T, Coleman H, et al. Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy. J Clin Nurs. 2023;32(13–14):3730–45. https://doi.org/10.1111/jocn.16582

Mianda S, Voce A. Developing and evaluating clinical leadership interventions for frontline healthcare providers: a review of the literature. BMC Health Serv Res. 2018;18(1):1–15. https://doi.org/10.1186/s12913-018-3561-4

Veronesi G, Kirkpatrick I, Vallascas F. Clinicians on the board: what difference does it make? Soc Sci Med. 2013;77:147–55. https://doi.org/10.1016/j.socscimed.2012.11.019

Ferreira TDM, de Mesquita GR, de Melo GC, et al. The influence of nursing leadership styles on the outcomes of patients, professionals and institutions: an integrative review. J Nurs Manag. 2022;30(4):936–53. https://doi.org/10.1111/jonm.13592

Boamah SA. Emergence of informal clinical leadership as a catalyst for improving patient care quality and job satisfaction. J Adv Nurs. 2019;75(5):1000–9. https://doi.org/10.1111/jan.13895

Dickinson H, Ham C. Engaging doctors in leadership: review of the literature. Birmingham: University of Birmingham; 2008.

Hershkovich O, Gilad D, Zimlichman E, et al. Effective medical leadership in times of emergency: a perspective. Disaster Mil Med. 2016;2:1–5. https://doi.org/10.1186/s40696-016-0013-8

Stoller JK. Developing physician-leaders: a call to action. J Gen Intern Med. 2009;24:876–8. https://doi.org/10.1007/s11606-009-1007-8

Warren OJ, Carnall R. Medical leadership: why it’s important, what is required, and how we develop it. Postgrad Med J. 2011;87(1023):27–32. https://doi.org/10.1136/pgmj.2009.093807

Griffith R. NHS management inquiry: report to the secretary of state for social services. London: Department of Health and Social Security; 1983.

Braithwaite J. Changing how we think about healthcare improvement. BMJ. 2018;361. https://doi.org/10.1136/bmj.k2014

Clay-Williams R, Ludlow K, Testa L, et al. Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors? BMJ Open. 2017;7(9):e014474. https://doi.org/10.1136/bmjopen-2016-014474

Nieuwboer MS, van der Sande R, van der Marck MA, et al. Clinical leadership and integrated primary care: a systematic literature review. Eur J Gen Pract. 2019;25(1):7–18. https://doi.org/10.1080/13814788.2018.1515907

Dwyer AJ. Roles, attributes and career paths of medical administrators in public hospitals: survey of victorian metropolitan directors of Medical services. Aust Health Rev. 2010;34(4):506–13. https://doi.org/10.1071/AH09750

Dwyer AJ. Medical managers in contemporary healthcare organisations: a consideration of the literature. Aust Health Rev. 2010;34(4):514–22. https://doi.org/10.1071/AH09736

Health Workforce Australia. Health LEADS Australia: the Australian health leadership framework. Adelaide: Health Workforce Australia; 2013.

NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges. Medical leadership competency framework: enhancing engagement in medical leadership. Coventry: NHS Institute for Innovation and Improvement; 2010.

National Centre for Healthcare Leadership. NCHL Health Leadership Competency Model 3.0. National Centre for Healthcare Leadership. 2022. https://www.nchl.org/research/ . Accessed 28 December, 2023.

NHS Leadership Academy. Healthcare Leadership Model: the nine dimensions of leadership behaviour. Leeds: NHS Leadership Academy; 2013.

Frank JR, Snell L, Sherbino J, et al. CanMEDS 2015 Physician Competency Framework. Royal College of Physicians and Surgeons of Canada; 2015.

Dath DCM-K, Anderson G, Burke A, Razack S, Lieff S, Moineau G, Chiu A, Ellison P. Leader. In: Frank JRSL, Sherbino J, editors. CanMEDS 2015 Physician Competency Framework. Royal College of Physicians and Surgeons of Canada; 2015.

Royal Australasian College of Medical Administrators. Medical Leadership and Management Curriculum Framework. Malvern, Victoria: Royal Australasian College of Medical Administrators; 2011.

Best S, Stark Z, Brown H, et al. The leadership behaviors needed to implement clinical genomics at scale: a qualitative study. Genet Med. 2020;22(8):1384–90. https://doi.org/10.1038/s41436-020-0818-1

Thoma B, Karwowska A, Samson L, et al. Emerging concepts in the CanMEDS physician competency framework. Can Med Educ J. 2023;14(1):4–12. https://doi.org/10.36834/cmej.75591

Ahern S, Loh E. Leadership during the COVID-19 pandemic: building and sustaining trust in times of uncertainty. BMJ Lead. 2020;leader–2020. https://doi.org/10.1136/leader-2020-000271

Braithwaite J, Churruca K, Hibbert P, et al. At the heart of getting things done in complex healthcare ecosystems: leadership, strategy, sensemaking and sensegiving. In: Chambers N, editor. Research Handbook on Leadership in Healthcare. Edward Elgar Publishing; 2023. pp. 775–92.

Braithwaite J, Fisher G. Beyond the aspirational: creating the future of health care in Australia. Int Med J. 2024;54(2):342–7. https://doi.org/10.1111/imj.16286

Cernega A, Nicolescu DN, Meleșcanu Imre M, et al. Volatility, uncertainty, complexity, and ambiguity (VUCA) in healthcare. Healthc. 2024;12(7):773. https://doi.org/10.3390/healthcare12070773

Kasula BY. Revolutionizing healthcare delivery: innovations and challenges in supply chain management for improved patient care. Trans Latest Trends Health Sect. 2023;15(15).

Niaz M, Nwagwu U. Managing healthcare product demand effectively in the post-covid-19 environment: navigating demand variability and forecasting complexities. Am J Econ Manag Bus. 2023;2(8):316–30. https://doi.org/10.58631/ajemb.v2i8.55

Thirumalai S, Devaraj S. Mitigating the curse of complexity: the role of focus and the implications for costs of care. J Oper Manag. 2024;70(1):157–79. https://doi.org/10.1002/joom.1278

Savage M, Savage C, Brommels M, et al. Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature. BMJ Open. 2020;10(7):e035542. https://doi.org/10.1136/bmjopen-2019-035542

Ahti M, Taipale-Walsh L, Kuha S, et al. Health-care leaders’ experiences of the competencies required for crisis management during COVID-19: a systematic review of qualitative studies. Leadersh Health Serv. 2023. https://doi.org/10.1108/LHS-10-2022-0104

Krasikova DV, Green SG, LeBreton JM. Destructive leadership: a theoretical review, integration, and future research agenda. J Manag. 2013;39(5):1308–38. https://doi.org/10.1177/0149206312471388

Pellegrini MM, Ciampi F, Marzi G, et al. The relationship between knowledge management and leadership: mapping the field and providing future research avenues. J Knowl Manag. 2020;24(6):1445–92. https://doi.org/10.1108/JKM-01-2020-0034

Paré G, Trudel M-C, Jaana M, et al. Synthesizing information systems knowledge: a typology of literature reviews. Inf Manag. 2015;52(2):183–99. https://doi.org/10.1016/j.im.2014.08.008

Heath A, Levay P, Tuvey D. Literature searching methods or guidance and their application to public health topics: a narrative review. Health Info Libr J. 2022;39(1):6–21. https://doi.org/10.1111/hir.12414

Adams J, Hillier-Brown FC, Moore HJ, et al. Searching and synthesising ‘grey literature’and ‘grey information’in public health: critical reflections on three case studies. Syst Rev. 2016;5(1):1–11. https://doi.org/10.1186/s13643-016-0337-y

Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https://doi.org/10.7326/M18-0850

Wolters Kluwer Health I. Get to know the advantages of Ovid MEDLINE ® . 2024. https://tools.ovid.com/ovidtools/medline.html . Accessed.

Stansfield C, Dickson K, Bangpan M. Exploring issues in the conduct of website searching and other online sources for systematic reviews: how can we be systematic? Syst Rev. 2016;5:1–9. https://doi.org/10.1186/s13643-016-0371-9

Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:1–10. https://doi.org/10.1186/s13643-016-0384-4

Peters MD, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26. https://doi.org/10.11124/JBIES-20-00167

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616

Best S, Long J, Stark Z, et al. Clinical leadership and genomics - what works? Twin Res Hum Genet. 2019;22(5):350. 43rd Annual Scientific Meeting of the Human Genetics Society of Australasia, HGSA 2019. Wellington New Zealand.

Crabtree BF, Howard J, Miller WL, et al. Leading innovative practice: leadership attributes in LEAP practices. Milbank Q. 2020;98(2):399–445. https://doi.org/10.1111/1468-0009.12456

Woiceshyn J, Huq JL, Kannappan S, et al. We need to work differently in a crisis: peer-professional leadership to redesign physicians’ work. BMJ Lead. 2022;6(2):98–103. https://doi.org/10.1136/leader-2021-000490

Appelbaum NP, Liang C, Whitney SE, et al. What business competencies are needed for the modern physician leader and when. Physician Leadersh J. 2022;9(2):39–45.

Hopkins J, Fassiotto M, Ku MC, et al. Designing a physician leadership development program based on effective models of physician education. Health Care Manage Rev. 2018;43(4):293–302. https://doi.org/10.1097/HMR.0000000000000146

Sandberg DS, Pennington CM, Lindquist MA. Virtual leadership: CEOs and C-Level executives of healthcare organizations in the United States reimagined new roles as virtual leaders. J Leadersh Stud. 2022;16(3):61–9. https://doi.org/10.1002/jls.21827

Satiani B, Dawson K, Mehta LS, et al. Lessons learned after implementing an academic faculty leadership program over seven years. Physician Leadersh J. 2022;9(2):30–8.

Angood PB. Transitions and transformations — our choice? Physician Leadersh J. 2022;9(5):6–8.

Brace R, James D. Adapting to changing roles. J Healthc Manag. 2020;35(3):46–7.

Wright C, Pister K. New thinking leads to better transitions. Physician Leadersh J. 2018;5(1):38–40.

Ramirez B, West DJ Jr, Ramirez CL. Healthcare and leadership competencies, training methods, and venues. J Leadersh Acc Ethics. 2021;18(4):93–9.

Wain MJ, Handel DA, Williford K, et al. Transitioning from physician to hospital leader: a competency-based model. Physician Leadersh J. 2020;7(2):32–3.

Borgwardt HL, Botz CT, Doppler JM, et al. Electronic health record implementation: the people side of change. Manage Healthc. 2019;4(1):7–20.

Anandaciva S. The biggest hospital in England. The King’s Fund . 2020. https://www.kingsfund.org.uk/blog/2020/09/biggest-hospital-england . Accessed 25 February, 2023.

Bailey S, West M. Learning from staff experiences of Covid-19: let the light come streaming in. The King’s Fund . 2020. https://www.kingsfund.org.uk/blog/2020/06/learning-staff-experiences-covid-19 . Accessed 26 February, 2023.

Bailey S, West M. Naming the issue: chronic excessive workload in the NHS. The King’s Fund . 2021. https://www.kingsfund.org.uk/blog/2021/06/naming-issue-chronic-excessive-workload-nhs . Accessed 26 February, 2023.

Bhopal A, Hood G. From disaster preparedness to digital disruption: A whistle-stop tour through public health. Faculty of Medical Leadership and Management. 2018. https://www.fmlm.ac.uk/news-opinion/from-disaster-preparedness-to-digital-disruption-a-whistle-stop-tour-through-public . Accessed 27 February, 2023.

Cheetham J. How Leaders in Healthcare 2020 gave an enlightened spotlight to junior doctor leadership. Faculty of Medical Leadership and Management. 2021. https://www.fmlm.ac.uk/news-opinion/how-leaders-in-healthcare-2020-gave-an-enlightened-spotlight-to-junior-doctor . Accessed 27 February, 2023.

Collins B. Leadership and innovation during Covid-19: lessons from the Cardiff and Vale Health System. The King’s Fund . 2021. https://www.kingsfund.org.uk/blog/2021/05/leadership-innovation-covid-19-cardiff-vale . Accessed 27 February, 2023.

Cottey L. The trainee and the team. Faculty of Medical Leadership and Management. 2018. https://www.fmlm.ac.uk/news-opinion/the-trainee-and-the-team . Accessed 28 February, 2023.

Dixon M. Engaging the public in designing the future for the NHS. The King’s Fund . 2018. https://www.kingsfund.org.uk/blog/2018/01/engaging-public-designing-future-nhs . Accessed 28 February, 2023.

Leveson D. Developing clinical leaders through innovation. The King’s Fund . 2021. https://www.kingsfund.org.uk/blog/2021/03/developing-clinical-leaders-through-innovation . Accessed 25 February, 2023.

Naylor C. Getting to grips with climate change: how can the NHS get to net zero? The King’s Fund . 2020. https://www.kingsfund.org.uk/blog/2020/01/climate-change-nhs-net-zero . Accessed 19 February, 2023.

Tweedie J. Leadership - so what is it anyway? February, 2018. https://www.fmlm.ac.uk/news-opinion/blog/leadership-so-what-is-it-anyway

Faculty of Medical Leadership and Management. FMLM response to HEE’s Call for Evidence on the Future Doctor. Faculty of Medical Leadership and Management. 2019. https://www.fmlm.ac.uk/news-opinion/fmlm-response-to-hees-call-for-evidence-on-the-future-doctor . Accessed 23 February, 2023.

Faculty of Medical Leadership and Management. Supporting and developing a leading resource for the future. Faculty of Medical Leadership and Management. 2021. https://www.fmlm.ac.uk/news-opinion/supporting-and-developing-a-leading-resource-for-the-future . Accessed 27 February, 2023.

Faculty of Medical Leadership and Management. Support, wellbeing and leadership. Faculty of Medical Leadership and Management. 2021. https://www.fmlm.ac.uk/news-opinion/support-wellbeing-and-leadership . Accessed 27 February, 2023.

Faculty of Medical Leadership and Management. Reflections from the International Healthcare Leadership Conference. 2022. Faculty of Medical Leadership and Management. 2022. https://www.fmlm.ac.uk/news-opinion/reflections-from-the-international-healthcare-leadership-conference-2022 . Accessed 27 February, 2023.

Lakhani M, Osuji N, Lees P et al. FMLM statement: racism and good leadership are incompatible. Faculty of Medical Leadership and Management. 2020. https://www.fmlm.ac.uk/news-opinion/fmlm-statement-racism-and-good-leadership-are-incompatible . Accessed 28 February, 2023.

Dougall D, Ross S. Transformational change in health and care: reports from the field. 2018. Accessed February, 2023. The King’s Fund.

Fogden R, Buck D, Franklin B et al. Poverty and the health and care system: the role of data and partnership in bringing change. The King’s Fund . 2022. https://www.kingsfund.org.uk/publications/poverty-health-care-system-data-partnership . Accessed 27 February, 2023.

Ham C, Murray R. The NHS 10-year plan: how should the extra funding be spent. The King’s Fund . 2018. https://www.kingsfund.org.uk/publications/nhs-10-year-plan . Accessed 28 February, 2023.

Swanwick T, McKimm J. The assessment of leadership development in the medical undergraduate curriculum: a consensus statement. Faculty of Medical Leadership and Management. 2020. https://www.fmlm.ac.uk/resources/the-assessment-of-leadership-development-in-the-medical-undergraduate-curriculum-a . Accessed 22 February, 2023.

Evans P. A radical upward shift to benefit members and fellows. Faculty of Medical Leadership and Management. 2020. https://www.fmlm.ac.uk/news-opinion/a-radical-upward-shift-to-benefit-members-and-fellows . Accessed 22 February, 2023.

Lakhani M. Black History Month and why it matters. Faculty of Medical Leadership and Management. 2021. https://www.fmlm.ac.uk/news-opinion/black-history-month-and-why-it-matters . Accessed 28 February, 2023.

Moralee S, Exworthy M, Rajasingam D et al. What next for medical leaders? Faculty of Medical Leadership and Management. 2018. https://www.fmlm.ac.uk/resources/what-next-for-medical-leaders . Accessed 25 February, 2023.

Warren S, Laverty A. Leading with compassion: supporting the health and wellbeing of NHS staff. The King’s Fund . 2022. https://www.kingsfund.org.uk/audio-video/podcast/leading-compassion-health-wellbeing-nhs-staff . Accessed 22 February, 2023.

Hancock M. Matt Hancock at The King’s Fund annual conference 2018. 2018. https://www.kingsfund.org.uk/audio-video/matt-hancock-kings-fund-annual-conference-2018 . Accessed.

Olsson-Brown A, Interview with Dr Anna Olsson-Brown - Chair of the Academy of Medical Royal Colleges Trainee Group. Faculty of Medical Leadership and Management. 2020. https://www.fmlm.ac.uk/news-opinion/interview-with-dr-anna-olsson-brown-chair-of-the-academy-of-medical-royal-colleges . Accessed 19 February, 2023.

Denicolai S, Previtali P. Innovation strategy and digital transformation execution in healthcare: the role of the general manager. Technovation. 2023;121:102555. https://doi.org/10.1016/j.technovation.2022.102555

Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, et al. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med. 2023;6(1):161. https://doi.org/10.1038/s41746-023-00899-4

Braithwaite J, Churruca K, Ellis LA, et al. Complexity science in healthcare: aspirations, approaches, applications, and accomplishments. A white paper. Sydney: Australian Institute of Health Innovation, Macquarie University; 2017.

Coiera E. Why system inertia makes health reform so difficult. BMJ. 2011;342 https://doi.org/10.1136/bmj.d3693

Clay-Williams R, Travaglia J, Hibbert P, et al. Clinical Governance Framework. A Report prepared for the Royal Australasian College of Medical Administrators (RACMA). Melbourne: RACMA; 2017.

Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. BMJ. 2001;323(7315):746–9. https://doi.org/10.1136/bmj.323.7315.746

van Diggele C, Burgess A, Roberts C, et al. Leadership in healthcare education. BMC Med Educ. 2020;20:1–6. https://doi.org/10.1186/s12909-020-02288-x

Golden RE, Klap R, Carney DV, et al. Promoting learning health system feedback loops: experience with a VA practice-based research network card study. Healthc. 2021;8:100484. https://doi.org/10.1016/j.hjdsi.2020.100484

Smith CL, Fisher G, Dharmayani PNA, et al. Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems’ responses to pandemics and climate change. BMC Med. 2024;22(1):131. https://doi.org/10.1186/s12916-024-03345-8

Hunt RC, Struminger BB, Redd JT, et al. Virtual peer-to-peer learning to enhance and accelerate the health system response to COVID-19: the HHS ASPR Project ECHO COVID-19 Clinical rounds Initiative. Ann Emerg Med. 2021;78(2):223–8. https://doi.org/10.1016/j.annemergmed.2021.03.035

Mander R, Hellert U, Antoni CH. Self-leadership strategies for coping with flexibility requirements of digital work with a high degree of latitude for time, place and scope for action—a qualitative study. Gr Interakt Org. 2021;52:163–71. https://doi.org/10.1007/s11612-021-00560-2

Vay C, Steinherr V. Leadership in a digitalized and crisis-ridden world: towards a comprehensive overview of relevant competencies for leaders. University of Hawaiʻi at Mānoa; 2023.

Churruca K, Pomare C, Ellis LA, et al. Patient-reported outcome measures (PROMs): a review of generic and condition‐specific measures and a discussion of trends and issues. Health Expect. 2021;24(4):1015–24. https://doi.org/10.1111/hex.13254

Best A, Greenhalgh T, Lewis S, et al. Large-system transformation in health care: a realist review. Milbank Q. 2012;90(3):421–56. https://doi.org/10.1111/j.1468-0009.2012.00670.x

Bolden R, Kars-Unluoglu S, Jarvis C, et al. Paradoxes of multi-level leadership: insights from an integrated care system. J Change Manag. 2023;23(4):337–57. https://doi.org/10.1080/14697017.2023.2234388

Braithwaite J, Dammery G, Spanos S, et al. Learning health systems 2.0: future-proofing healthcare against pandemics and climate change. A White Paper. Sydney: Australian Institute of Health Innovation, Macquarie University; 2023.

Download references

Acknowledgements

The authors thank Mary Simons and Jeremy Cullis for their specialist guidance on database searches.

This work was funded in part by RACMA. RACMA contributed to the conceptualization and design of the research. JB is funded and supported by an NHMRC Leadership Investigator Award (1176620).

Author information

Authors and affiliations.

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia

Samantha Spanos, Elle Leask, Romika Patel, Michael Datyner & Jeffrey Braithwaite

Royal Australasian College of Medical Administrators, Melbourne, VIC, Australia

You can also search for this author in PubMed   Google Scholar

Contributions

JB and SS led the research conception and design. SS, ELe, and RP executed the research, and acquired, and analyzed the data. JB, SS, and MD significantly contributed to the interpretation of the data. SS wrote the original manuscript draft which was critically reviewed by JB, ELe, RP, MD and ELo. SS led the manuscript revisions with significant contribution from JB, and input from ELe, RP, MD, and ELo. All authors agree on the journal to which the article will be submitted, have reviewed, and approved the manuscript, and agree to be personally accountable for its contents.

Corresponding author

Correspondence to Samantha Spanos .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Spanos, S., Leask, E., Patel, R. et al. Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies. BMC Med Educ 24 , 720 (2024). https://doi.org/10.1186/s12909-024-05689-4

Download citation

Received : 13 February 2024

Accepted : 21 June 2024

Published : 03 July 2024

DOI : https://doi.org/10.1186/s12909-024-05689-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Physician leadership
• Future health care
• Future healthcare
• Complex systems

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]