Leading With HEART©: Equine-Assisted Leadership Training Fosters Emotional Intelligence, Resilience, and Identity Formation in First-Year Osteopathic Medical Students

Abstract Purpose Burnout, emotional dysregulation, and lack of resilience are prevalent among medical students and professionals contributing to stress and burnout. Despite recognition that emotional regulation, leadership capacity, and PIF are essential competencies, medical education provides limited structured training in these domains. The Holistic Equine-Assisted Resilience Training (HEART©) curriculum was developed to address these gaps through integration of HeartMath ® biofeedback, equine-assisted learning and experiential leadership development. This study evaluated the effects of HEART© on physiological regulation, well-being, resilience, and leadership-related competencies among first-year osteopathic medical students. Methods A mixed-methods, nonrandomized pretest–posttest design compared a treatment group receiving the five-week HEART© curriculum intervention with a control group that did not receive training. Quantitative measures included heart rate variability for those in the treatment group, the Medical Student Well-Being Index, and the 14-item Resilience Scale completed by both the treatment and control group. Qualitative data were collected via semi-structured interviews of the treatment group participants and analyzed using inductive phenomenological thematic analysis. Qualitative analysis identified themes of increased emotional awareness, improved selfregulation, and greater alignment between thoughts (head) and feelings (heart). Participants described horses as providing immediate, nonjudgmental feedback that facilitated experiential learning. Results Treatment group participants demonstrated significant improvements in heart rate variability and coherence and MSWBI scores, indicating improved autonomic regulation and reduced stress. The analysis reflected a significant increase in resilience for the treatment group compared with the control group. Conclusions The HEART© curriculum was associated with measurable physiological and psychological benefits and supported development of emotional regulation and leadership-related competencies in OMS-1 participants.