Abstract Introduction Early leadership development is an increasing focus in both military and civilian undergraduate medical education, where physicians are expected to lead multidisciplinary teams and perform under complex, high-stakes conditions. Despite a growing number of leadership training programs, few studies have evaluated the longitudinal progression of leadership competencies across medical school using standardized, validated tools. The Uniformed Services University (USU) has implemented a longitudinal leadership curriculum grounded in the Leader-Follower (LF2) Framework, which includes 4 core elements: Character, Competence, Context, and Communication. This study aimed to determine whether leadership performance during a third-year immersive field practicum (Operation Gunpowder) correlates with and predicts subsequent performance in a fourth-year practicum (Operation Bushmaster) using the same standardized assessment approach. Materials and Methods This observational cohort study included 151 students from USU’s class of 2025 who completed both military field practicums (MFP). Both MFPs assessed students using a validated 5-item leadership evaluation tool aligned with the LF2 framework. Each element was rated on a 4-point Likert scale. Pearson correlation coefficients were calculated to assess associations between MFP leadership scores. Best subset regression was used to identify which Gunpowder leadership elements best predicted Bushmaster performance. The study was approved by the USU Institutional Review Board (Protocol Number: KM83XV). Results The total leadership score from Gunpowder was positively correlated with the total score from Bushmaster. Among individual elements, only Leadership Transcendent Skills (LTS) and Role-Specific Competence during Gunpowder showed positive correlations with their corresponding Bushmaster scores. LTS in Gunpowder was significantly correlated with all 5 leadership elements in Bushmaster, while Role-Specific Competence correlated with all Bushmaster elements except Communication. Regression analysis identified LTS as the strongest and most consistent predictor of Bushmaster performance across multiple domains, including Character, Communication, and LTS itself. In contrast, Role-Specific Competence from Gunpowder only predicted the same element in Bushmaster. The overall Gunpowder sum score was not a significant predictor of any individual Bushmaster element. Conclusions This study demonstrates that specific leadership traits assessed early in medical school, particularly LTS, predict future leadership performance in operationally realistic environments. The cross-domain predictive power of LTS suggests it may serve as a transferable core skill analogous to Trait Emotional Intelligence (Trait EI), reinforcing its potential value in early leadership curricula. In contrast, Role-Specific Competence appeared to be context-bound and limited in broader predictive impact. A key strength of this study is its use of standardized, longitudinal, non-self-report assessment data within a single institution’s evolving yet consistently framed leadership curriculum. Limitations include the single-institution design and lack of post-graduate performance data. Future studies should assess reproducibility across cohorts, examine long-term predictive value into residency, and explore generalizability to civilian training programs.
Pierce et al. (Wed,) studied this question.