Emergency care competencies for non–emergency medicine specialists in Japan: a modified Delphi study
- 1Department of General Medicine, Sapporo Medical University, Sapporo, Hokkaido Japan
- 2Minamihiyama Regional Medical Education Course, Sapporo Medical University, Sapporo, Hokkaido Japan
- 3Department of General Medicine, Shiga University of Medical Science, Otsu, Shiga Japan
Abstract
Background: Physicians from specialties other than emergency medicine (non-EM specialists) provide first-contact emergency care in many health systems. Existing emergency care courses and competency frameworks address resource-limited first-contact care or rural self-sufficient practice, but do not define the role-specific competencies expected of non-EM specialists in high-resource, specialist-limited settings. This study aimed to develop a consensus-based set of core emergency care competencies for non-EM specialists in Japan.
Methods: We conducted a modified Delphi consensus study from January to March 2026. A balanced national panel of 50 specialists, comprising 25 EM and 25 non-EM specialists, rated emergency care items on a 7-point Likert scale. Items were adopted if they met all predefined criteria: median score ≥ 6, ≥ 80% of ratings in the 6–7 range, and quartile deviation ≤ 1.0. Items were classified as consensus non-adoptions if median score ≤ 3, ≥ 70% of ratings in the 1–3 range, and quartile deviation ≤ 2.0, or as non-adopted by persistent lack of consensus if they met neither set of criteria across two consecutive rounds. Items were generated from a structured review of training documents and iteratively revised using panellist feedback.
Results: Of the 50 enrolled panellists, 48, 42, and 41 completed Rounds 1, 2, and 3, respectively. From an initial pool of 121 items, 38 reached adoption consensus: 23 in Round 1 and 15 in Round 2. Adopted competencies clustered around recognition of acute deterioration, interpretation of laboratory and imaging findings, initial stabilisation, judgement of indications for specialist-level intervention, and timely escalation. Several high-risk invasive procedures, including cricothyrotomy, chest tube insertion, pericardiocentesis, and intubation for non-arrest patients, did not reach consensus as universal core competencies for non-EM specialists.
Conclusions: Expert consensus defined a distinct, role-specific competency profile for non-EM specialists in Japan, weighted towards recognition, diagnostic interpretation, clinical judgement, initial stabilisation, and escalation rather than a reduced version of EM specialist training. The resulting 38 competencies provide content validity evidence for a minimum core of emergency care education aligned with the role non-EM specialists are expected to perform.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-10094-0.
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BibTeX
@article{jinno2026emergency,
title = {{Emergency care competencies for non–emergency medicine specialists in Japan: a modified Delphi study}},
author = {Atsushi Jinno and Shuichi Miyamoto and Kazuhito Nomura and Hiroshi Mihara and Masanori Shiratori and Yoshihisa Tsuji},
journal = {BMC Medical Education},
year = {2026},
month = aug,
doi = {10.1186/s12909-026-10094-0},
url = {https://doi.org/10.1186/s12909-026-10094-0},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Emergency care competencies for non–emergency medicine specialists in Japan: a modified Delphi study
AU - Atsushi Jinno
AU - Shuichi Miyamoto
AU - Kazuhito Nomura
AU - Hiroshi Mihara
AU - Masanori Shiratori
AU - Yoshihisa Tsuji
PY - 2026
DA - 2026/08/08
JO - BMC Medical Education
DO - 10.1186/s12909-026-10094-0
UR - https://doi.org/10.1186/s12909-026-10094-0
AB - Background: Physicians from specialties other than emergency medicine (non-EM specialists) provide first-contact emergency care in many health systems. Existing emergency care courses and competency frameworks address resource-limited first-contact care or rural self-sufficient practice, but do not define the role-specific competencies expected of non-EM specialists in high-resource, specialist-limited settings. This study aimed to develop a consensus-based set of core emergency care competencies for non-EM specialists in Japan. Methods: We conducted a modified Delphi consensus study from January to March 2026. A balanced national panel of 50 specialists, comprising 25 EM and 25 non-EM specialists, rated emergency care items on a 7-point Likert scale. Items were adopted if they met all predefined criteria: median score ≥ 6, ≥ 80% of ratings in the 6–7 range, and quartile deviation ≤ 1.0. Items were classified as consensus non-adoptions if median score ≤ 3, ≥ 70% of ratings in the 1–3 range, and quartile deviation ≤ 2.0, or as non-adopted by persistent lack of consensus if they met neither set of criteria across two consecutive rounds. Items were generated from a structured review of training documents and iteratively revised using panellist feedback. Results: Of the 50 enrolled panellists, 48, 42, and 41 completed Rounds 1, 2, and 3, respectively. From an initial pool of 121 items, 38 reached adoption consensus: 23 in Round 1 and 15 in Round 2. Adopted competencies clustered around recognition of acute deterioration, interpretation of laboratory and imaging findings, initial stabilisation, judgement of indications for specialist-level intervention, and timely escalation. Several high-risk invasive procedures, including cricothyrotomy, chest tube insertion, pericardiocentesis, and intubation for non-arrest patients, did not reach consensus as universal core competencies for non-EM specialists. Conclusions: Expert consensus defined a distinct, role-specific competency profile for non-EM specialists in Japan, weighted towards recognition, diagnostic interpretation, clinical judgement, initial stabilisation, and escalation rather than a reduced version of EM specialist training. The resulting 38 competencies provide content validity evidence for a minimum core of emergency care education aligned with the role non-EM specialists are expected to perform. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-10094-0.
SN - 1472-6920
ER -