{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:24:28Z","timestamp":1788315868395,"version":"build-2803163510"},"reference-count":38,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"unspecified","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2025,10,13]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Effective leadership during trauma resuscitation is a determinant of team performance and patient outcomes, yet existing training curricula remain procedure-centric and do not explicitly address the leadership domain. A structured, competency-based framework tailored to the resuscitation context may support more consistent training, evaluation, and entrustment of emerging trauma leaders. A narrative review of the literature was conducted across MEDLINE, Embase and Scopus using terms related to trauma, leadership, non-technical skills and competency frameworks. Relevant publications were categorized into: (1) leadership theory and styles; (2) non-technical skills frameworks; (3) trauma resuscitation education and assessment and (4) high-reliability team training from allied domains. Concepts were synthesized to derive a set of core competencies for trauma resuscitation leadership. Five interdependent competencies were identified: (1) adaptive leadership style matched to clinical context; (2) time-bound decision-making under uncertainty; (3) communication strategies that balance clarity with brevity; (4) fostering psychological safety and team coordination and (5) ongoing self-reflection with coached feedback. A continuum of leadership styles, spanning directive to facilitative, was adapted to the acute resuscitation environment. Educational modalities proposed include high-fidelity simulation, structured video review, in-situ coaching and behavioral checklists linked to entrustable professional activities. The framework delineates leadership training as distinct from, but complementary to, established technical protocols such as Advanced Trauma Life Support. This competency-based framework provides a structured approach to developing trauma resuscitation leadership skills. By defining observable behaviors, mapping them to multimodal training methods and proposing evaluation strategies, it offers a basis for systematic integration into trauma education. The framework may enhance reproducibility of training, strengthen team performance and improve patient care in high-acuity environments. Level of evidence: Narrative review.<\/jats:p>","DOI":"10.1136\/tsaco-2025-001975","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T07:05:14Z","timestamp":1762326314000},"page":"e001975","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Surgeon leadership in trauma resuscitation requires a competency-based multimodal training framework"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1918-9443","authenticated-orcid":false,"given":"Gary Alan","family":"Bass","sequence":"first","affiliation":[{"name":"Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Center for Emergency Surgery 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