title: Trauma leadership: does perception drive reality?
abstract: BACKGROUND
  Leadership plays a key role in trauma team management and might affect the efficiency of patient care. Our hypothesis was that a positive relationship exists between the trauma team members' perception of leadership and the efficiency of the injured patient's initial evaluation.
  
  
  METHODS
  We conducted a prospective observational study evaluating trauma attending leadership (TAL) over 5 months at a level 1 trauma center. After the completion of patient care, trauma team members evaluated the TAL's ability using a modified Campbell Leadership Descriptor Survey tool. Scores ranged from 18 (ineffective leader) to 72 (perfect score). Clinical efficiency was measured prospectively by recording the time needed to complete an advanced trauma life support (ATLS)-directed resuscitation. Assessment times across Leadership score groups were compared using Kruskal-Wallis and Mann-Whitney tests (p < 0.05, statistically significant).
  
  
  RESULTS
  Seven attending physicians were included with a postfellowship experience ranging from ≤1 to 11 years. The average leadership score was 59.8 (range, 27-72). Leadership scores were divided into 3 groups post facto: low (18-45), medium (46-67), and high (68-72). The teams directed by surgeons with low scores took significantly longer than teams directed by surgeons with high scores to complete the secondary survey (14 ± 4 minutes in contrast to 11 ± 2 minutes, p < 0.009) and to transport the patient for CT evaluation (19 ± 5 minutes in contrast to 14 ± 4 minutes; p < 0.001). Attending surgeon experience also affected clinical efficiency with teams directed by less experienced surgeons taking significantly longer to complete the primary survey (p < 0.05).
  
  
  CONCLUSIONS
  The trauma team's perception of leadership is associated positively with clinical efficiency. As such, more formal leadership training could potentially improve patient care and should be included in surgical education.
authors.affiliation: Trauma Center at Penn, University of Pennsylvania, Philadelphia, PA, USA. Joseph.Sakran@uphs.upenn.edu
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Sakran
authors.forename: Bo
authors.initials: B
authors.lastname: Finneman
authors.forename: Chris
authors.initials: C
authors.lastname: Maxwell
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Jose
authors.initials: J
authors.lastname: Pascual
authors.forename: Patrick
authors.initials: P
authors.lastname: Kim
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Carrie
authors.initials: C
authors.lastname: Sims
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011787:Quality of Health Care; D012151:Resuscitation / Q000592:standards / Q000639:trends; D012307:Risk Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014194:Traumatology / Q000458:organization & administration; D014481:United States