Leadership and Teamwork in Trauma and Resuscitation.
BACKGROUND
Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.


METHODS
We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders.


RESULTS
We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance.


CONCLUSIONS
Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership's effect on patient-level outcome.
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California.
Kelsey
K
Ford
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California.
Michael
M
Menchine
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California.
Elizabeth
E
Burner
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California.
Sanjay
S
Arora
Keck School of Medicine of the University of Southern California, Department of Surgery, Los Angeles, California.
Kenji
K
Inaba
Keck School of Medicine of the University of Southern California, Department of Surgery, Los Angeles, California.
Demetrios
D
Demetriades
University of Lausanne, Department of Medicine, Lausanne, Switzerland.
Bertrand
B
Yersin
D002983:Clinical Competence; D003299:Cooperative Behavior; D006282:Health Personnel / Q000193:education; D006801:Humans; D007857:Leadership; D011787:Quality of Health Care; D012151:Resuscitation / Q000379:methods; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries