Management and leadership competencies in Emergency Medicine specialist training: a review with implications for African programmes

Introduction Management and leadership are core competency domains in emergency medicine (EM) specialist training worldwide, yet they remain less clearly articulated and less consistently assessed than clinical skills, particularly in African and other low- and middle-income country (LMIC) settings. Methods Review of peer-reviewed and grey literature. Electronic searches of PubMed/MEDLINE, CINAHL, ERIC, and Web of Science were conducted from database inception to March 2026, supplemented by hand-searching of five journals and six organisational repositories. Sources were included if they described management or leadership competencies, educational approaches, assessment methods, or outcomes within postgraduate EM training. Results Survey data suggest young African EM specialists feel least prepared in manager and scholar roles. Six recurring competency domains were identified: team leadership; operational and resource management; quality improvement and patient safety; health advocacy; interprofessional and organisational dynamics; and self-management. The most granular taxonomy is a Canadian modified Delphi producing 59 consensus competency statements. Assessment approaches include simulation-based tools, multi-source feedback, and workplace-based methods, with validation evidence concentrated in high-income countries. No validated assessment tools or outcome data for management and leadership competencies were identified from African EM programmes. Discussion African EM curricula would benefit from contextually adapted competency statements and assessment strategies. A three-phase development pathway is proposed: (1) an African Delphi consensus process using the domains identified in this review as a starting framework; (2) contextual validation of assessment tools; and (3) embedded implementation science studies within existing curriculum reforms.