The purpose of medical education has changed over the last 70 years. The modern doctor is expected to be a leader who will be skilled in people management, team working and patient engagement. Moreover, the burgeoning literature on the development of medical leadership competency frameworks as a way to inform curriculum development is evidence of a desire to empower physicians to be healthcare leaders. The movement towards developing medical students as leaders has to be contrasted against the fact that high school exam performance and academic achievement continues to be the primary basis for selection to medical school. Not surprisingly, the smart kids are studying medicine. Unfortunately, there is a person–job mismatch between the initial skills that allows an individual entry to medical school and what the job will actually entail. For example, higher levels of intelligence are associated with less effective leadership styles. Thus, we seem to have a conundrum concerning input and output. In the following paper, I will examine the degree to which we are attempting to remould ‘square’ physicians to fit them into a ‘round’ medical landscape. The purpose of the paper is twofold. First, to assess the degree to which we can realistically expect the ‘average’ medical student to be moulded into a leader, and second, to identify what practical steps we can take to enable medical students to take a leadership role.