Integrating Leadership and Technical Skills: Insights From Prolonged Casualty Care During Operation Gunpowder

Military medical providers must rapidly assess and treat casualties while managing prolonged care in resource-limited environments. Tactical Combat Casualty Care and Prolonged Casualty Care (PCC) provide structured frameworks for battlefield medicine, but training often separates technical and leadership development. To address this gap, Operation Gunpowder at the Uniformed Services University was adapted to integrate leadership and clinical skills. This study examines the relationships between student leadership performance, self-reported training experiences, and faculty and peer evaluations.

This study analyzed data from 203 third-year medical and graduate nursing students participating in the 36-hour Operation Gunpowder field practicum. Leadership performance was assessed using the Leader-Follower Framework, which evaluates Character, Context, Competence, Communication, and Leadership Transcendent Skills. Students completed post-practicum surveys and reflections, and Pearson correlations were conducted between survey responses and leadership performance ratings. Qualitative responses were reviewed for themes related to quantitative findings.

In each squad, students who rated Primary Survey, Wound Care, or Evacuation Skills as useful had lower leadership performance scores, particularly in Character (r = -0.46 to -0.52, P < .05) and Communication (r = -0.46, P < .05). Confidence in PCC knowledge was positively correlated with adaptability (Context, r = 0.44, P < .05), suggesting that early PCC training may improve situational responsiveness. Squads that found hands-on practice most beneficial had lower Communication scores (r = -0.48, P < .05), indicating potential gaps in team coordination. Students who prepared for less than 1 hour before the practicum performed better in leadership dimensions, including Communication (r = 0.56, P < .01).

These findings highlight challenges in integrating leadership into technical skills training. Enhancing PCC exposure, embedding communication exercises in hands-on training, and optimizing pre-practicum preparation may improve leadership development. Insights from this study can inform refinements to military medical training, including Operation Bushmaster, to better prepare future military medical officers for battlefield decision-making and leadership.