Identifying themes for EMS continued competency that are acceptable and improve patient care

OBJECTIVES: Continued competency in emergency medical services (EMS) remains inconsistently defined, and existing frameworks have not been systematically re-evaluated to ensure alignment with contemporary EMS practice, acceptability to clinicians, and relevance to patient care. The objective of this study was to derive and prioritize foundational principles to guide development of an updated EMS continued competency model that would be acceptable to EMS clinicians and support improvement in competency and patient care. METHODS: We conducted a four-round, in-person modified qualitative Delphi study with a multidisciplinary panel of EMS subject matter experts, including frontline clinicians, educators, medical directors, agency leaders, and state EMS officials. In Round 1, panelists responded to open-ended prompts to generate concepts related to acceptable and effective continued competency models. These inputs were synthesized into themes and iteratively refined through structured group discussion. In Round 2, panelists rated each theme for acceptability to EMS clinicians and perceived impact on competency and patient care using five-point Likert-type scales. In Round 3, themes meeting predefined cut criteria were rank ordered. In Round 4, panelists engaged in consensus-building discussions to identify a prioritized set of principles. Consensus was defined a priori as at least 75% agreement. RESULTS: Fifteen experts participated in all Delphi rounds, contributing several hundred open-ended responses that were synthesized into 22 unique themes. Through iterative refinement and ranking, the panel achieved unanimous consensus on five foundational principles to guide an updated EMS continued competency model: educational content must be evidence-based; EMS clinicians must have an active role in competency development; assessment priorities should be informed by quality assurance and quality improvement data; competency assessment should be non-punitive and growth oriented; and the model must be feasible and scalable across EMS settings. Four additional themes were identified as operational strategies that support implementation, including simulation-based assessment, longitudinal competency development, microlearning, and technology-enabled delivery. CONCLUSIONS: Using expert consensus, this modified Delphi study identified a set of foundational and operational principles to guide development of an updated EMS continued competency model. These findings provide a structured, evidence-informed framework to support future design, evaluation, and implementation efforts across diverse EMS systems.