We read with great interest the recent study by Hirata et al, A Questionnaire Study of Leadership in General Medicine: General Physicians in Japan are Facing Challenges in Education and Research.1 The study provides valuable insights into the leadership dynamics among general physicians in Japan, particularly highlighting the need for transformational leadership in education and research. As medical education and clinical practice continue to evolve, this study underscores the importance of strengthening leadership training in general medicine.

Further exploration is needed to clarify the rationale behind the classification of physicians’ years of experience. The study categorizes respondents into ≤ 5 years (2.8%), 6–10 years (10.5%), and ≥ 11 years (86.7%), but additional context would enhance interpretability. Aligning these categories with Japan’s professional development milestones, such as postgraduate residency (PGY1–PGY3), specialist training (PGY4+), and senior leadership roles, would provide clearer insights.2 Additionally, specifying whether the 11-year threshold marks clinical independence, department leadership, or research engagement would improve comparability across medical career trajectories.

Additionally, the study reports that 4.9% of respondents were residents and 74.9% were supervisors or department chairpersons, leaving 20.2% unaccounted for. Clarifying whether this includes attending physicians, mid-career specialists, or faculty members would provide a more comprehensive view of leadership experiences. Since leadership expectations vary across career stages, a detailed breakdown of participant roles would strengthen the discussion on leadership development needs at different points in a physician’s career.3

The finding that 24% of respondents were uncertain about research leadership highlights a significant gap in structured training for physician-researchers. As evidence-based medicine and interdisciplinary collaboration gain importance, mentorship programs, leadership workshops, and research training pathways are essential to prepare physicians for research leadership. Institutional differences may influence leadership preferences, with some settings favoring directive leadership and others benefiting from transformational or democratic approaches. Future research, rooted in the lived experiences of all stakeholders, should explore how leadership training can be effectively tailored to diverse research environments.4

The study underscores that leadership training should be an integral part of medical education, rather than an ancillary skill. Integrating structured leadership development into general medicine residency and specialty programs could enhance physicians’ effectiveness in clinical practice, education, and research.5 However, key questions remain: How should leadership training be implemented? Should it be mandatory in residency programs or part of continuous professional development? Should training be career-stage specific, emphasizing directive leadership for early-career physicians and transformational leadership for senior roles? Future studies should explore longitudinal assessments to evaluate its impact on physician performance, interdisciplinary collaboration, and patient care outcomes.

As general medicine continues to evolve, equipping physicians with the appropriate leadership competencies is essential. I commend the authors for addressing this critical issue and advocate for the implementation of targeted leadership training initiatives to bridge existing gaps. Further research should examine career-stage-specific leadership development needs, the impact of structured training, and institutional factors influencing leadership adoption in Japan’s healthcare system.

Chongqing Municipal Education Commission Humanities and Social Sciences Project – Research on the Construction and Practice of an Innovation and Entrepreneurship Education System in Medical Schools under the New Medical Science Background.

The authors report no conflicts of interest in this communication.

1. Hirata R, Tago M, Takahashi H, et al. A questionnaire study of leadership in general medicine: general physicians in Japan are facing challenges in education and research. Int J Gen Med. 2024;17:5465–5470. doi:10.2147/IJGM.S490806

2. Watari T, Nishizaki Y, Houchens N, et al. Medical resident’s pursuing specialty and differences in clinical proficiency among medical residents in Japan: a nationwide cross-sectional study. BMC Med Educ. 2023;23(1):464. doi:10.1186/s12909-023-04429-4

3. Mousa M, Boyle J, Skouteris H, et al. Advancing women in healthcare leadership: a systematic review and meta-synthesis of multi-sector evidence on organisational interventions. EClinical Med. 2021;39:101084. doi:10.1016/j.eclinm.2021.101084

4. Xiao ZS, Zhou H, Jiang YL, Samah NA. Embracing the complexity of lived experiences in psychiatry research: reflexivity, cultural sensitivity, and emergent design. World J Psychiatry. 2024;14(12):1793–1796. doi:10.5498/wjp.v14.i12.1793

5. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. Leadership development programs for physicians: a systematic review. J Gen Intern Med. 2015;30(5):656–674. doi:10.1007/s11606-014-3141-1