Forming the humanistic leader: a systematic review of arts and humanities in medical education

BACKGROUND: Arts and humanities (A&H) are increasingly used in medical education to address and mitigate burnout and professional disengagement. While their role in humanising clinical practice is recognised, their impact on leadership development remains insufficiently synthesised. OBJECTIVE: To systematically review empirical studies evaluating the effects of A&H interventions on undergraduate (UG) and postgraduate (PG) medical learners, focusing on outcomes formation, explicitly linked to leadership awareness, ensuring development, such as ethical decision-making, team management and system awareness, ensuring relevance for educators and policymakers. METHODS: This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of six databases (PubMed, Scopus, ScienceDirect, Directory of Open Access Journals (DOAJ), Education Resources Information Center (ERIC) and Excerpta Medica dataBASE (EMBASE) was conducted for studies published from January 2000 to 15 May 2024. Eligible studies included empirical evaluations of diverse A&H-based interventions, such as literature, visual arts, theatre and narrative ethics, targeting UG or PG medical trainees and measuring leadership-related outcomes. RESULTS: Thirty-two studies were included. Empathy was the most frequently assessed outcome (n=21), with high-certainty evidence supporting improvements from interventions using literature, narrative writing, visual arts and theatre. Visual arts training significantly enhanced diagnostic observation (n=3; Grading of Recommendations, Assessment, Development and Evaluation (GRADE): high). Reflective capacity and professional identity formation were strengthened by literature, narrative and art-based methods (GRADE: moderate). Improvisation and performance-based interventions improved communication and collaboration (n=6; GRADE: moderate). Although underrepresented, A&H interventions also showed early potential in addressing emotional resilience and burnout. CONCLUSIONS: A&H interventions contribute meaningfully to developing leadership competencies in medical education, especially empathy, ethical reflection and identity formation. Their integration into curricula can be a strategic step toward cultivating humanistic clinical leaders.