Arts-based empathy education in healthcare: a critical systematic review of pedagogical mechanisms and evidence gaps

Objectives To systematically identify and synthesise the pedagogical mechanisms through which arts-based interventions (theatre, poetry, narrative medicine) may support empathy development in healthcare learners, while critically appraising the contextual implementation factors and methodological limitations of the existing evidence base. Design Systematic review with narrative synthesis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources MEDLINE (via PubMed), Embase, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and CINAHL Plus, from inception to 31 August 2025. Eligibility criteria for selecting studies Peer-reviewed empirical studies involving undergraduate or postgraduate healthcare students or professionals.

Eligible studies reported on arts-based educational interventions designed to enhance empathy (including theatre, poetry or narrative medicine) and included quantitative or qualitative outcome measures of empathy or related constructs. No restrictions were placed on study design.

Data extraction and synthesis Two reviewers independently screened records, extracted data on intervention characteristics and outcomes, and assessed methodological quality using the Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme tools.