Summary of literature review and cross-sectional surveyLiterature review

A summary table of the competencies and curricula identified in the literature search is provided in Supplementary file 3. There were 19 articles describing 15 competency models and curricula for health workers and professionals [25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]. On six occasions, curricula alongside a competency model were listed [25,26,27,28,29, 33,34,35, 41, 43], on another six occasions, competency models alone were described [32, 36, 38,39,40, 42]. In the remaining three, only curricula were described [30, 31, 37].

Cross-sectional survey

Sixty-five responses were received in the online survey. The response rate was estimated to be 25%, based on the number of invitations sent by email. However, the exact response rate is not known as recipients of the invitation email were encouraged to forward the invitation to other relevant potential respondents. The survey did not generate any additional competency model or curriculum. Table 1 shows the summary profile of the responding agencies. Most respondents were from academic institutions (60%), followed by those from national governments (19%).

Table 1 Summary profile of respondents’ agencies (n=57)

Twenty-one respondents (32%) reported that their agencies had defined the core competencies for Health EDRM managers and frontline responders while 20 respondents (31%) listed the contents in the curricula provided for the managers and frontline responders.

Competency models from literature review and survey

Among the 12 competency models identified in the literature review, the majority were from the US. Most papers included expert panel reviews while some used the Delphi method for building consensus. Most models were all-hazard in coverage although a few had been developed specifically to counter bioterrorism. Most papers focused on public health workers, but some also targeted public health managers and professionals while others focused on health professionals of various disciplines. Most competency models included knowledge and skills, emergency response systems (including incident management principles), communications, critical thinking, ethical and legal aspects, and managerial and leadership skills. Some competency models provided specific competencies for different tiers of frontline and managerial personnel [25,26,27, 29, 36].

Table 2 shows the detailed responses from the survey. Management skills were most commonly described, including planning, organizing, applying management processes, establishing effective communication systems, and providing effective leadership (95-100% of respondents). Fewer respondents reported the requirement of management skills for frontline workers, except for effective communication systems (90%).

Table 2 Percentage of respondents with management and technical competencies required by their institutions and the coverage from the training curricula provided for Health EDRM managers and frontline personnel

Managers were expected to master a wide range of technical competencies. However, seven items were less frequently included as required competencies for frontline workers (<60% of respondents): 1. human resource management, 2. managing emergency operations centres, 3. managing monitoring and evaluation systems, 4. surge capacity planning, 5. program management, 6. development of Health EDRM policies, strategies and legislation, and 7. financial resources – planning and managing budgets.

Curricula from the literature review and survey

The majority of the nine identified curricula were from the US. Six articles described a proposed curriculum to address a specific competency model. Structured short training programs like the Core/Basic/Advanced Disaster Life Support and the National Disaster Life Support Decontamination courses [37] were geared towards delivering specific disaster preparedness and response knowledge and skills in 8-16 hours. More extended curricula, including those by CDC/ Columbia University School of Nursing [28, 30, 31, 33], were self-paced and included 15 activities to cover various competencies. Some curricula included exercises and simulation-based training [37, 41, 43].

Three of the six curricula described how the candidates were assessed against defined competencies (Supplementary file 3g). There were no standardized assessment methods: a wide variety of assessments were used, including pre- and post-test scores, self-assessment or trainer-rated performance, exercises (including simulation-based ones) performance results, and observed field-based performance.

Most of the curricula cover the required management and technical competencies across prevention, preparedness, response, and recovery for managers and frontline workers. However, “understanding community capacities, leadership and involvement” and “cultural competencies” were less often covered in curricula (75%). Training delivered by institutions included practical skills training and tabletop/full-scale exercises (85%), followed by blended learning (70%), didactic teaching (65%), online training (65%) and work-based mentorship (55%). Program duration was usually less than one week (40%) or longer than one year (35%). Only 20% were 1-4 weeks and 5% were 1-6 months. Among training modalities that required recertification (55% of the responses), most required recertification every 1-2 years (45%).

Gaps in competencies and curricula

Gaps in competencies and curricula were identified by comparing the above findings with WHE core competencies and Health EDRM principles. WHE core competencies include six areas, namely 1. Moving forward in a changing environment, 2. Applying technical expertise, 3. Communication, 4. Teamwork, 5. Building and promoting partnerships, and 6. Leadership. By comparison, none of the 15 competency models and curricula identified in the literature review and survey included the area of “moving forward in a changing environment,” and only one curriculum covered “teamwork” (Fig. 2, Supplementary file 3d). “Leadership” was only included in three of the 15 competency models and curricula. Most competency models encompassed technical competencies on disaster preparedness and response, but fewer included technical competencies on recovery.

Fig. 2

Percentage of published competency models and curricula covering the WHE core competencies and Health EDRM principles

The Health EDRM principle of a comprehensive emergency management perspective (across prevention, preparedness, readiness, response, and recovery) was only included in two models/curricula. The Health EDRM risk-based approach that emphasizes reducing hazards, exposures, and vulnerabilities was only included in three models or curricula (Fig. 2).

The competency models and curricula cited by survey respondents included a higher coverage of the WHE core competencies and the Health EDRM principles than those identified from the literature review (Supplementary 3e and f). However, gaps were still seen in the risk-based approach and technical competencies in emergency recovery and leadership.

Research priorities for developing Health EDRM competencies (from survey respondents)

Thirty-one survey respondents (48%) provided their views on research priorities for developing Health EDRM competencies in their countries. Effective leadership and planning for Health EDRM were ranked as the most important research priorities for managerial and frontline personnel (Table 3).

Table 3 Research priorities in developing Health EDRM competencies in your country for Health EDRM managers and frontline personnel (n=31)