Although the U.S. health care system embodies high medical expertise and advanced technology, it fails to meet the minimum needs of millions of Americans.1 Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care.2,3 To help solve these crises, health care organizations need outstanding leadership. Excellent leadership creates environments that influence people to follow chosen directions, thereby influencing the actions of individuals, groups, and organizations.4 For instance, physician leadership across professional, social, and regulatory agencies has contributed significantly to the reduction of tobacco use in the U.S. during the last five decades.5Physicians remain uniquely situated to lead on issues adversely affecting health care because of their knowledge, their experience, and the respect of the physician's role in society.6 To effectively lead, physicians must possess not only excellent clinical skills but also excellent leadership skills.7Calls for increasing the number of trained physician leaders have come from many places.1,8,9 The Institute of Medicine, for one, has stated that increased physician leadership and opportunities for leadership training would help redesign the health care system for the 21st century.1 As a result of these calls, the creation of leadership training programs for physicians has occurred across many settings, including those affiliated with major universities (e.g., Yale University, University of Tennessee), private companies (e.g., Center for Creative Leadership, Advisory Board Academies), and professional organizations (e.g., American Medical Association, American Academy of Family Physicians).10,11 Most of these programs enroll physicians posttraining and vary from weekend courses to two-year degree programs that may lead to certificates of medical management or master degrees in business administration or health administration.11 Although the creation of physician leadership programs has begun to extend to a few residency programs, the number of physicians graduating with skills necessary to take on leadership roles in practice remains insufficient given the large challenges facing health care.6,11–13To ensure that physician leaders continue to emerge, one option is to integrate leadership training in community service into the undergraduate medical school curricula. Medical students understand that their training forms the core of what they need to know as future physicians. Exposing medical students to leadership training in community service during medical school may validate leadership concepts and help mitigate the tendency of students as they progress through training to feel less idealistic about medicine and more negative toward the underserved.14–18Currently, medical students receive little exposure to leadership concepts while in training. Research from the Association of American Medical Colleges (AAMC) shows that whereas two thirds of graduating medical students report delivering clinical care to underserved populations, only one third report field experiences in service, only one fifth report working directly with diverse community groups, and up to one half report inadequate instruction in health care systems, medical economics, community medicine, and public health.19 The AAMC curriculum directory lists only three medical schools as offering leadership courses, and few published data exist about the outcomes of these courses.20Leadership competencies in community service include not just knowledge and attitudes but also a broad set of skills such as coalition building, policy advocacy, fundraising, program planning, motivation, and facilitation—skills not taught in the medical curriculum. The most successful learning environments combine content knowledge with practical application, but few models exist for how to combine needed leadership competencies with actual service opportunities in the medical curriculum.21Two medical schools have reported ways of offering leadership training to medical students. One program involves an integrated leadership and medical degree curricula, but this program requires an additional year of training, something most medical schools and medical students are not likely to choose.22 Another medical school, the University of Wisconsin School of Medicine, has a program called LOCUS (Leadership Opportunities with Communities, the Underserved, and Special Populations) that seeks to improve medical students' leadership, knowledge, and skills through community service, but the program is not a curricular offering but, instead, a longitudinal, extracurricular activity.23 Finally, the American Medical Student Association conducts an annual Primary Care Leadership Training Program that focuses on primary care, leadership skills, curricular reforms, and health policy issues,24 but only a limited number of medical and dental students may attend.The “Advanced Leadership Skills in Community Service” (ALSCS) offers a new model for training undergraduate medical students in leadership skills. The course is available annually to second-year medical students at the University of North Carolina at Chapel Hill School of Medicine (UNC SOM). It is 1 of 13 semester-long selectives that students can choose in a required humanities and social sciences course. Between 12 and 14 students have enrolled in ALSCS for each of the last five years. This article describes the development, philosophical framework, curriculum and assessment, and initial outcomes of the ALSCS course.