jats:pFrontline doctors’ clinical leadership (CL) is key to addressing healthcare sustainability challenges. Research shows CL requires professional learning. Significant investments into CL development notwithstanding, little evidence exists of how frontline clinicians learn leadership, highlighting an educational sustainability challenge. We propose a fundamental constitutive step towards understanding CL professional development (PD) through theorising and analysing CL-learning mechanisms and their association with clinicians’ leadership competences required for sustainable healthcare development. This mixed-methods study developed a concept of leadership learning patterns to assess doctors’ learning processes associated with sustained innovation. It analysed a post-course dataset of past participants of a CL-PD course (N = 150) and a pre-post dataset of an online CL-PD (N = 34). EFA demonstrated a reasonable factor model for the Leadership Learning Inventory, measuring two dimensions of doctors’ leadership learning patterns: Meaning-oriented and Problematic learning. Qualitative and quantitative analyses showed that Meaning-oriented learning increased significantly during CL-PD and is linked with sustainable leadership competences. This study suggests that the concept of leadership learning patterns is useful for evaluating the quality of clinical leadership learning processes during PD. It offers a conceptually and empirically sound way to assess clinical leadership learning involved in sustainable healthcare improvement, and the sustainability of educational interventions to support it.</jats:p>