National Registry of Emergency Medical Technicians, Columbus, Ohio.
Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.
Prehosp Emerg Care. 2023;27(4):439-448. doi: 10.1080/10903127.2022.2120934. Epub 2022 Oct 12.
Continued competency is poorly defined in emergency medical services (EMS), with no established method for verifying continued competency at a national level. The objective of this project was to refine understanding of continued competency for EMS clinicians in the U.S. and establish priorities for developing competency assessments.
A panel of EMS managers, educators, medical directors, and experts in competency assessment, simulation, and certification used a modified Delphi technique to address two questions: "What is the content for continued competency in EMS that should be assessed or verified?" (content) and "How should continued competency of EMS clinicians be demonstrated?" (process). The Delphi process was conducted through electronic conferencing and survey software over a 6-month period. In round one, panelists responded to open-ended prompts and their contributions were analyzed and categorized into themes by independent reviewers. In round two, the panel rated theme importance using five-point Likert-type scales. In round three, the panel ranked their top 10 themes, and in round four, the panel selected the most important themes for each of the two questions through consensus-building discussions. Descriptive statistics and thematic analyses were performed with Excel and STATA 16.
Fourteen invited experts participated in all Delphi activities. The panel contributed 70 content and 35 process items from the original prompts. Following thematic analysis, these contributions were reduced to 21 and 14 unique themes, respectively. The final top five prioritized themes for content important for continued competency included (1) airway, respiration, and ventilation, (2) patient assessment, (3) pharmacology, (4) pediatrics, and (5) management of time critical disease progressions. The final top five prioritized themes for the processes for continued competency assessment included (1) assessments of evidence-based practice, (2) performance-based assessments, (3) combined knowledge and skill assessments, (4) performance improvement over time, and (5) frequent, short knowledge assessments.
This modified Delphi process identified priorities for content and assessment, laying the groundwork for EMS continued competency at a national level. These findings can be leveraged by national task forces to develop transparent and consistent guidelines for systems that verify continued competency related to certification, licensure, and local credentialing.
在紧急医疗服务（EMS）中，继续胜任能力的定义很差，在国家层面上没有建立验证继续胜任能力的既定方法。本项目的目的是深入了解美国 EMS 临床医生的继续胜任能力，并确定制定胜任能力评估的优先事项。
一组 EMS 经理、教育工作者、医疗主任和胜任能力评估、模拟和认证方面的专家使用改良 Delphi 技术来回答两个问题：“EMS 中应评估或验证哪些内容以确定继续胜任能力？”（内容）和“EMS 临床医生应如何展示继续胜任能力？”（过程）。德尔菲法过程通过电子会议和调查软件进行，历时 6 个月。在第一轮中，小组成员对开放式提示做出回应，他们的贡献由独立评审员进行分析和分类归入主题。在第二轮中，小组成员使用五点 Likert 量表对主题重要性进行评分。在第三轮中，小组成员对前 10 名主题进行排名，在第四轮中，小组通过共识建立讨论为每个问题选择最重要的主题。使用 Excel 和 STATA 16 进行描述性统计和主题分析。
14 名受邀专家参加了所有 Delphi 活动。小组成员从原始提示中提供了 70 个内容和 35 个过程项目。经过主题分析，这些贡献分别减少到 21 个和 14 个独特的主题。内容方面继续胜任能力的最终前 5 个重点主题包括（1）气道、呼吸和通气，（2）患者评估，（3）药理学，（4）儿科，（5）时间关键疾病进展的管理。继续胜任能力评估过程的最终前 5 个重点主题包括（1）基于证据的实践评估，（2）基于绩效的评估，（3）知识和技能综合评估，（4）随着时间的推移绩效改进，以及（5）频繁、简短的知识评估。
这项改良的 Delphi 过程确定了内容和评估的优先事项，为国家层面的 EMS 继续胜任能力奠定了基础。这些发现可以被国家工作组利用，为与认证、许可和本地认证相关的继续胜任能力验证制定透明和一致的指南。
