Emergency care competencies for non–emergency medicine specialists in Japan: a modified Delphi study

Abstract

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.