title: Adaptive leadership curriculum for Indian paramedic trainees.
abstract: BACKGROUND
  Paramedic trainees in developing countries face complex and chaotic clinical environments that demand effective leadership, communication, and teamwork. Providers must rely on non-technical skills (NTS) to manage bystanders and attendees, collaborate with other emergency professionals, and safely and appropriately treat patients. The authors designed a NTS curriculum for paramedic trainees focused on adaptive leadership, teamwork, and communication skills critical to the Indian prehospital environment.
  
  
  METHODS
  Forty paramedic trainees in the first academic year of the 2-year Advanced Post-Graduate Degree in Emergency Care (EMT-paramedic equivalent) program at the GVK-Emergency Management and Research Institute campus in Hyderabad, India, participated in the 6-day leadership course. Trainees completed self-assessments and delivered two brief video-recorded presentations before and after completion of the curriculum.
  
  
  RESULTS
  Independent blinded observers scored the pre- and post-intervention presentations delivered by 10 randomly selected paramedic trainees. The third-party judges reported significant improvement in both confidence (25 %, p < 0.01) and body language of paramedic trainees (13 %, p < 0.04). Self-reported competency surveys indicated significant increases in leadership (2.6 vs. 4.6, p < 0.001, d = 1.8), public speaking (2.9 vs. 4.6, p < 0.001, d = 1.4), self-reflection (2.7 vs. 4.6, p < 0.001, d = 1.6), and self-confidence (3.0 vs. 4.8, p < 0.001, d = 1.5).
  
  
  CONCLUSIONS
  Participants in a 1-week leadership curriculum for prehospital providers demonstrated significant improvement in self-reported NTS commonly required of paramedics in the field. The authors recommend integrating focused NTS development curriculum into Indian paramedic education and further evaluation of the long term impacts of this adaptive leadership training.
authors.affiliation: Stanford Emergency Medicine International, Division of Emergency Medicine, Stanford School of Medicine, Stanford, USA. amantha@stanford.edu.
authors.forename: Aditya
authors.initials: A
authors.lastname: Mantha
authors.affiliation: Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA. ncoggins@dgsom.edu.
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Coggins
authors.affiliation: University of California San Diego, San Diego, USA. amahadev@ucsd.edu.
authors.forename: Aditya
authors.initials: A
authors.lastname: Mahadevan
authors.affiliation: University of California Berkeley, Berkeley, USA. Rebecca.strehlow@berkeley.edu.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Strehlow
authors.affiliation: Division of Emergency Medicine, Stanford School of Medicine, Stanford, USA. strehlow@stanford.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Strehlow
authors.affiliation: Stanford Emergency Department, 300 Pasteur Dr., Alway Bldg M121 MC 5119, Stanford, CA, 94305, USA. s.mahadevan@stanford.edu.|Division of Emergency Medicine, Stanford School of Medicine, Stanford, USA. s.mahadevan@stanford.edu.
authors.forename: S V
authors.initials: SV
authors.lastname: Mahadevan
keywords: International emergency medicine; Interpersonal skills; Prehospital education