Preparing Emergency Medicine Residents to Lead Level 1 Multidisciplinary Trauma Teams: A Scoping Review.

Abstract

Background: In the United States, the initial management of trauma patients is coordinated by multidisciplinary teams, typically led by surgeons. As a result, Emergency Medicine (EM) residents often have limited experience in the trauma team lead role. However, in rural or critical access hospitals, EM physicians frequently serve as team leaders without surgical backup.

Objective: To map and summarize educational strategies used to train EM residents to lead Level 1 trauma resuscitations and describe how outcomes such as confidence, performance, and preparedness are assessed.

Methods: Following Joanna Briggs Institute scoping review methodology, a systematic search of PubMed and Embase was conducted. Inclusion criteria focused on training EM residents in trauma leadership using keywords related to education, competence, and leadership. Covidence was used for blinded screening and data extraction, and 23 studies were included following double-blind review.

Results: Simulation-based training dominated the literature, including high-fidelity mannequins, cadaver labs, animal models, and standardized patients. Combined approaches integrating didactics, video-assisted debriefs, and mental rehearsal improved trauma leadership, procedural, and nontechnical skills. Most studies evaluated outcomes using self-reported confidence and perceived competence, while fewer used validated performance assessment tools in simulated settings, and only one study evaluated resident leadership in real-world trauma activations. Studies also assessed psychosocial constructs such as confidence and stress.

Conclusion: Existing literature describes simulation as the most frequently used modality for trauma leadership training among EM residents, often paired with structured debriefing, didactics, mental rehearsal, and progressive complexity. Most studies assess learner-reported outcomes and simulated performance, while real-world clinical leadership assessment remains limited. Future efforts should prioritize curriculum development, standardized evaluation tools (Kirkpatrick or milestone-based outcomes), and longitudinal models that combine simulation with real-world practice to ensure consistent, high-quality trauma leadership preparation.