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Medical science educator2026; 36(3); 1371-1383; doi: 10.1007/s40670-026-02686-8

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

Abstract: 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. Unassigned: 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. Unassigned: 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. Unassigned: 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.
© The Author(s) 2026.
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Publication Date: 2026-03-17 PubMed ID: 42438496PubMed Central: PMC13356005DOI: 10.1007/s40670-026-02686-8Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study investigates the impact of the Holistic Equine-Assisted Resilience Training (HEART©) curriculum on emotional intelligence, resilience, and professional identity formation in first-year osteopathic medical students.
  • The curriculum combines biofeedback, equine-assisted learning, and leadership development to address emotional regulation and stress management deficiencies common in medical education.

Background and Rationale

  • Medical students and professionals often experience high levels of burnout, emotional dysregulation, and reduced resilience, which contribute to increased stress and negatively affect their well-being.
  • Key competencies such as emotional regulation, leadership skills, and professional identity formation (PIF) are recognized as essential but are typically underrepresented in structured medical education curricula.
  • The need exists for innovative training methods aimed at improving these competencies to enhance student well-being and professional development.

The HEART© Curriculum

  • HEART© stands for Holistic Equine-Assisted Resilience Training, a novel five-week intervention designed to foster emotional regulation, resilience, and leadership capabilities.
  • The curriculum integrates:
    • HeartMath biofeedback technologies to teach physiological regulation techniques such as heart rate variability (HRV) control.
    • Equine-assisted learning, using interactions with horses that provide immediate, nonjudgmental feedback, facilitating experiential learning about self-awareness and emotional responses.
    • Experiential leadership development exercises to promote reflection on leadership identity and skills.

Study Design and Methods

  • A mixed-methods, nonrandomized pretest-posttest design was employed.
  • Participants were first-year osteopathic medical students (OMS-1), divided into:
    • A treatment group receiving the HEART© curriculum over five weeks.
    • A control group that did not receive any intervention.
  • Quantitative measures included:
    • Heart rate variability (HRV) and coherence measured only in the treatment group to assess autonomic regulation physiologically.
    • Medical Student Well-Being Index (MSWBI), assessing stress and well-being, completed by both groups.
    • 14-item Resilience Scale, measuring psychological resilience, completed by both groups.
  • Qualitative data:
    • Semi-structured interviews conducted with treatment group participants.
    • Inductive phenomenological thematic analysis performed to identify meaningful themes related to emotional and leadership development.

Key Findings

  • Qualitative Themes:
    • Increased emotional awareness among participants, indicating better recognition and understanding of their own emotions.
    • Improved self-regulation, referring to enhanced capacity to manage emotional responses and stress.
    • Greater alignment between cognitive processes (“head”) and feelings (“heart”), reflecting integrated emotional and intellectual processing important in leadership.
    • Participants perceived horses as providing immediate, honest, and nonjudgmental feedback that contributed to learning through direct experience.
  • Quantitative Results:
    • Treatment group showed significant improvements in heart rate variability and coherence, indicating better autonomic nervous system regulation related to emotional control.
    • MSWBI scores improved in the treatment group, reflecting reduced perceived stress and enhanced well-being.
    • Resilience scores increased significantly in the treatment group compared to controls, suggesting that the HEART© curriculum effectively strengthens psychological resilience.

Conclusions and Implications

  • The HEART© equine-assisted leadership training provided measurable physiological and psychological benefits for first-year osteopathic medical students.
  • The program effectively enhances emotional regulation, resilience, and leadership-related competencies, addressing critical gaps in medical education.
  • Integration of experiential learning with biofeedback and animal-assisted modalities offers a promising approach to cultivating well-being and professional identity formation in healthcare trainees.
  • This intervention may serve as a model for other medical schools seeking innovative strategies to reduce burnout and foster holistic development in students.

Cite This Article

APA
Lutz B, Scheve J, Lilley S, Bohecker L, Holstun V, Love K, McKinnon JC, Strivings A, Ramerth T, Severance S. (2026). Leading With HEART©: Equine-Assisted Leadership Training Fosters Emotional Intelligence, Resilience, and Identity Formation in First-Year Osteopathic Medical Students. Med Sci Educ, 36(3), 1371-1383. https://doi.org/10.1007/s40670-026-02686-8

Publication

Medical science educator
ISSN: 2156-8650
NlmUniqueID: 101625548
Country: United States
Language: English
Volume: 36
Issue: 3
Pages: 1371-1383

Researcher Affiliations

Lutz, Barb
  • Liberty University College of Osteopathic Medicine, 306 Liberty View Lane, Lynchburg, VA 24502 USA.
Scheve, Jessica
  • Liberty University College of Osteopathic Medicine, 306 Liberty View Lane, Lynchburg, VA 24502 USA.
Lilley, Stacey
  • School of Behavioral Sciences, Liberty University, Lynchburg, VA USA.
Bohecker, Lynn
  • School of Behavioral Sciences, Liberty University, Lynchburg, VA USA.
Holstun, Vasti
  • School of Behavioral Sciences, Liberty University, Lynchburg, VA USA.
Love, Kim
  • K. R. Love Quantitative Consulting and Collaboration, Athens, GA USA.
McKinnon, Jon C
  • Nashville Rescue Mission, Nashville, TN USA.
Strivings, Amanda
  • Striving Onward Counseling Services, Leander, TX USA.
Ramerth, Teresa
  • Psychiatry, Liberty University College of Osteopathic Medicine, Lynchburg, VA USA.
Severance, Scott
  • Department of Molecular and Cellular Sciences, Liberty University College of Osteopathic Medicine, Lynchburg, VA USA.

Conflict of Interest Statement

Competing interestsLiberty University College of Osteopathic Medicine’s Department of Research and Grants provided funding to purchase the one-year license for the RS-14™ survey from The Resilience Center and one ear probe with HeartMath® emWave® Pro Plus software (HeartMath®, Boulder Creek, California).

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