Leadership training in obstetric care: A systematic review of educational interventions and outcomes

To evaluate the structure, implementation and reported outcomes of leadership training interventions in obstetric care.

Following PRISMA guidelines and PROSPERO registration (CRD420251248483), a systematic search of PubMed, Web of Science, and Scopus was conducted for English-language studies published between 2005 and 2025. Eligible studies evaluated leadership training interventions involving healthcare professionals working in obstetric settings, including obstetricians, midwives, nurses, anesthesiologists, and residents. Randomized, non-randomized, and pre-post interventional studies were included. Outcomes were categorized according to Kirkpatrick's four-level evaluation model. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Due to heterogeneity, findings were synthesized descriptively.

Ten studies met inclusion criteria. Interventions varied substantially in duration, format, and educational approach, with most incorporating simulation-based or multimodal strategies. Most interventions targeted individual learners (70%), with only two studies involving complete obstetric teams trained together. Outcome assessment relied predominantly on self-reported, non-validated questionnaires. Most studies reported improvements in perceived leadership knowledge, confidence, and skills. However, objective behavioral change was infrequently measured, and no study evaluated patient-level outcomes. The overall methodological quality was moderate (mean MERSQI score 10.1).

Leadership training in obstetric care is associated with improvements in self-reported competencies. However, current evidence is limited by methodological weaknesses, a predominance of subjective self-reported outcomes, scarce objective or behavioral assessments and absence of evaluation of patient-level outcomes. More rigorous, multidisciplinary, team-based programs are needed to establish clinical impact.