This paper reports the use of a stakeholder-based, bottom-up approach to determining leadership training needs and designing leadership training programs which contrasts with the top-down policy that is often applied. The context is a Canadian medical school. Leadership training in medicine is in its infancy. Discussed and outlined in this study are stakeholder opinions on the pillars and priorities upholding leadership development. Seventy-seven semi-structured interviews were conducted with stakeholder groups including Trainees, Mid-Level University Leaders, Senior Medical Clinician Leaders, Senior University Leaders, Medical Scientists and Senior Executives and Directors external to the University. Conventional content analysis was used to group the text into common themes and then group the themes into more general categories. Five general categories emerged: formal programming, organizational support, program evaluation, skill development and participant selection. A successful training program starts with identifying the individuals most likely to benefit from such a program. It emphasizes early training, mentorship and experiential learning. Programs should focus on developing: self-awareness, communication skills and team-building capability. Formal training programs would be most successful if they were regularly evaluated and strongly supported by their parent organizations.