Globally, 2013 was characterized by 330 natural disasters.Reference Guha-Sapir, Hoyois and Below 1 The poorest countries are typically the most affected, with a total of 5 low- or lower-middle income countries among the top 10 in terms of disaster mortality. Aid workers are often required to operate within disrupted political systems with no pre-existing disaster plansReference Willems, Waxman and Bacon 2 and to perform tasks that fall outside their area of expertise, especially the management of refugees and internally displaced populations, communicable diseases, and the lack of critical resources.Reference Birch and Miller 3 Lessons learned from relevant disasters—such as Haiti (2010), the Asian tsunami (2004), the Haiyan Typhoon (2013), and the current Ebola virus disease tragedies in West Africa—call for attention to the limited capability of foreign medical teams to meet challenges posed by complex emergencies.Reference Burkle, Lyznicki and James 4 - Reference Cranmer and Biddinger 9 These concerns have prompted the international community to devise means for the development of both competence and professionalism within the humanitarian assistance sector.Reference Burkle, Lyznicki and James 4 , Reference Djalali, Ingrassia and Corte 6
Disaster response demands a large workforce with diverse professional disciplines, subspecialty categories, and levels of professional experience and cultural expertise. Regardless of their professional background, education for personnel operating in disaster situations should be based on the acquisition of task-related, profession-specific, and cross-disciplinary competencies obtained through accredited education and training programs implemented by academically affiliated centers.Reference Johnson, Idzerda and Baras 10 - Reference Burkle 12
Competency-based education has already been implemented by several academic institutions worldwide. These programs traditionally build credibility based on the evaluation of trainees’ subsequent performance.Reference Leung 13 These educational initiatives often rely too heavily on competencies developed by single training programs and, as such, lack a “common standards” framework.Reference Daily, Padjen and Birnbaum 14 However, in this study, we strongly suggest that an agreed-upon set of cross-sectorial competencies would best provide the basis for standardized educational program framework.Reference Johnson, Idzerda and Baras 10 , Reference Burkle 12 , Reference Walsh, Subbarao and Gebbie 15 , Reference Schultz, Koenig and Whiteside 16 This would allow for the assessment of aid workers’ performance and knowledge acquisition based on their designated tasks and would further ensure international recognition and best-practices comparisonReference Kako and Mitani 17 by regulatory stakeholders.Reference Daily, Padjen and Birnbaum 14 Unfortunately, assessment of competency-based post-education and training skill sets has been sparse to date.Reference Cranmer, Chan and Kayden 18
This systematic review of peer-reviewed studies aims to identify existing competency sets for disaster management and humanitarian assistance that would serve as guidance for the development of a common disaster curriculum and content.
Methods
Study Design
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.Reference Liberati, Altman and Tetzlaff 19 The review included English-language papers published from January 2004 to January 2014 on PubMed, Google Scholar, Scopus, ERIC, and Cochrane Library.
Data Collection
A combination of the following keywords in the title was used: Disaster/s OR Public health emergency/ies OR Crisis/es OR Humanitarian OR Complex emergency/ies AND Competency/e/ies OR Ability/ies OR Knowledge OR Attitude/s OR Skill/s OR Professionalization. In addition, a grey-literature manual search was conducted to identify existing competency sets published on the websites of relevant universities, governmental organizations (GOs), nongovernmental organizations (NGOs), and other professional entities. Finally, an ancestry search was also performed to identify additional references on the reference section of the articles.
Inclusion Criteria
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▪ Articles reporting competencies or competency domains, abilities, knowledge, skills, or attitudes for professionals involved in disaster relief or humanitarian assistance.
Exclusion Criteria
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▪ Case studies;
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▪ Abstracts;
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▪ Citations;
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▪ Articles not specifically related to abilities or performance;
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▪ Articles not dealing with disasters or humanitarian assistance.
Titles and abstracts of the identified literature were scanned. Literature not complying with the inclusion criteria was excluded. The full text was obtained for uncertain articles, and references were independently screened and selected by two members of the research working group. When disagreement occurred, the opinion of a third reviewer was sought.
Data Analysis
References were described on the basis of their sectorial (eg, health, logistics, communication) and disciplinary approach (eg, emergency medicine, public health). Within a specific discipline, an additional distinction was made amongst different professional groups or cadres (eg, physicians, nurses, technicians) and proficiency levels (eg, informed worker/student, practitioner, and leader). Target audiences (eg, physicians, nurses, social workers) were also analyzed. Out of the selected papers, we described how many of them reported either competency domains, competencies, or subcompetencies. Additionally, we analysed the method used by authors to define the competency domains, competencies, and subcompetencies. When identified, performance objectives were also reported.
Results
The search strategy yielded a total of 1637 references; Reference Birch and Miller3 additional articles resulted from the manual search on the web, and 15 were drawn from the reference sections of other articles. After exclusion of duplicates, 1151 titles were identified for further screening. A total of 1072 titles and abstracts were removed according to the exclusion criteria. This resulted in 79 full-text articles; 4 full-text articles could not be retrieved, and 37 did not meet the inclusion criteria, leaving 38 references for analysis (Figure 1).Reference Willems, Waxman and Bacon 2 , Reference Burkle, Lyznicki and James 4 , Reference Subbarao, Lyznicki and Hsu 5 , Reference Daily, Padjen and Birnbaum 14 - Reference Schultz, Koenig and Whiteside 16 , 20 - Reference Mitchell, Doyle and Moran 51
Figure 1 Review Selection Process and Results
Twenty-seven references were peer-review articles,Reference Willems, Waxman and Bacon 2 , Reference Subbarao, Lyznicki and Hsu 5 , Reference Daily, Padjen and Birnbaum 14 - Reference Schultz, Koenig and Whiteside 16 , Reference Hodge, Gebbie and Hoke 21 , Reference Markenson, DiMaggio and Redlener 22 , Reference Jorgensen, Mendoza and Henderson 24 , Reference Van Wart and Kapucu 27 - Reference Hites, Lafreniere and Wingate 29 , Reference Weiner 31 - Reference More, Phelan and Boylan 34 , Reference Mosca, Sweeney and Hazy 36 , 37 , Reference Rottman, Shoaf and Dorian 38 - Reference Hsu, Thomas and Bass 40 , Reference Johnson, Gaskins and Seibert 42 , Reference Stanley 43 , Reference Everly, Beaton and Pfefferbaum 45 , Reference Yin, He and Arbon 48 - Reference Mitchell, Doyle and Moran 51 one was a book chapter,Reference Burkle, Lyznicki and James 4 4 were reports, 25 , 26 , 41 , 44 and 6 were documents available on the websites of relevant organizations. 20 , 23 , 30 , 35 , 46 , 47
Articles were referred to a single sector references. Only 5 (13%) reported cross-sectorial competencies (Table 1). 23 , 26 , Reference Van Wart and Kapucu 27 , 47 , Reference Mitchell, Doyle and Moran 51 Most of the articles (81.6%) were health care specific (Table 2) and, among them, 1 reported competencies for military health care staff.Reference Johnson, Gaskins and Seibert 42 Thirteen (34%) articles referred to a single discipline, 18 (47%) to at least 2 different disciplines, and 7 (18%) were determined to be unclear as to discipline specificity by the reviewers (Table 1). Eighteen articles (47%) included competencies for diverse professional groups. The most target audiences were nurses and disaster medicine and public health professionals (Table 3).
Table 1 Summary of Data Extraction for the Selected Literature: ✔ Yes; Ο No; NS Not Specified
Table 2 References Categorized by Targeted Sector
Table 3 References Categorized by Targeted Audience
Of the articles reviewed that specified global humanitarian response, only 18 (47%) articles defined competency domains. However, most of them referred to suggestive and poorly defined labels such as competency subject areas,Reference Markenson, DiMaggio and Redlener 22 competency areas,Reference Wisniewski, Dennik-Champion and Peltier 49 competency clusters, 26 and simply as competencies alone. 33 , 35 , 41 , 46
Thirty-six papers (94%) provided a list of competencies. Some authors named competencies as knowledge, 25 , Reference Mitchell, Doyle and Moran 51 competency description,Reference Weiner 31 , 41 , Reference Wisniewski, Dennik-Champion and Peltier 49 skills,Reference Willems, Waxman and Bacon 2 , Reference Van Wart and Kapucu 27 , Reference Yin, He and Arbon 48 , Reference Mitchell, Doyle and Moran 51 skills and knowledge,Reference Johnson, Gaskins and Seibert 42 , Reference Kamal, Songwathana and Sia 50 skills and traits,Reference Van Wart and Kapucu 27 , Reference Kovács, Tatham and Larson 39 or behaviors.Reference Van Wart and Kapucu 27 Only 5 (13%) of the articles described subcompetencies and 5 (13%) defined performance objectives.Reference Walsh, Subbarao and Gebbie 15 , Reference Schultz, Koenig and Whiteside 16 , Reference More, Phelan and Boylan 34 , Reference Hsu, Thomas and Bass 40 , 46
Thirty-one articles (81%) clearly described the method adopted to define competencies. A total of 19 (50%) used consensus-building,Reference Subbarao, Lyznicki and Hsu 5 , Reference Walsh, Subbarao and Gebbie 15 , Reference Schultz, Koenig and Whiteside 16 , 20 , Reference Markenson, DiMaggio and Redlener 22 – 26 , Reference Harrison, Davis and MacDonald 28 , Reference Hites, Lafreniere and Wingate 29 , Reference Weiner 31 – 33 , Reference Hsu, Thomas and Bass 40 , 41 , Reference Stanley 43 , 46 3 articles identified competencies by survey or self-assessment questionnaires,Reference Van Wart and Kapucu 27 , 37 , Reference Yin, He and Arbon 48 6 reported competencies based solely on a literature review,Reference Willems, Waxman and Bacon 2 , Reference Daily, Padjen and Birnbaum 14 , Reference Kovács, Tatham and Larson 39 , Reference Johnson, Gaskins and Seibert 42 , Reference Wisniewski, Dennik-Champion and Peltier 49 , Reference Kamal, Songwathana and Sia 50 and 4 reported or adapted competencies originally described by previously published articles.Reference Burkle, Lyznicki and James 4 , Reference Hodge, Gebbie and Hoke 21 , Reference Mosca, Sweeney and Hazy 36 , Reference Rottman, Shoaf and Dorian 38
A total of 12 (31%) defined competencies based on professional “responsibility” levels; 1 article defined competencies for frontline professional staff,Reference Hodge, Gebbie and Hoke 21 supervisory and management staff, health officials and governance boards, and senior level professional staff; 1 reported different levels of expected proficiency according to the disciplines being considered;Reference Markenson, DiMaggio and Redlener 22 1 supplied additional behaviors for first-level line managers in humanitarian response; and 2 included category-specific competencies for informed worker/students, practitioners, and leaders.Reference Subbarao, Lyznicki and Hsu 5 , Reference Jorgensen, Mendoza and Henderson 24 One paper included competencies for basic-, mid-, and advanced-level personnel involved in both chemical and nonchemical environments; 25 finally, 1 split competencies into 4 different levels of performance. 26
Discussion
This study reviewed the competencies published for professionals involved in disaster relief and humanitarian assistance regardless of their professional sector, discipline, role, or category.
Whereas the term competency embraces the set of knowledge, skills, and attitudes necessary to effectively and efficiently accomplish a task, this review revealed a lack of consensus even among the terminology used through different articles to define competency, competency domains, and so on. Likewise, a “competency statement” best describes the specific observable and measurable activities that individuals are able to perform.Reference Hodge, Gebbie and Hoke 21 , 44 , Reference Gebbie and Standish 52 Thus, a competency statement would be expected to include an action verb, describing the level of performance (eg, apply, recognize), a description of the subject matter, type of performance, outcome performance, or specific operational task (eg, disaster response or recovery, public health emergency), and the context to which the competency statement is referred.Reference Hodge, Gebbie and Hoke 21 , Reference Gebbie and Standish 52 To be effective, education and training require consensus on a set of core competencies with curricula based on a well-defined package of knowledge and skills. It is already well know that competency-based education and training represents the cornerstone in the professionalization of disaster medicine and humanitarian aid.Reference Burkle 53 Ultimately, definitional uniformity will also facilitate the establishment of this discipline at an operational level.
In a previous study, the disagreement in the terminology used among articles in defining these concepts was attributed to a general lack of understanding of the competency-based education framework or foundation building-process,Reference Daily, Padjen and Birnbaum 14 subcompetencies, and performance objectives.
While competency statements include a broad description of a task, performance objectives describe a specific outcome that workers are expected to accomplish as a result of their work activity. 54 Furthermore, they define measurable goals that can be used to evaluate learningReference Hsu, Thomas and Bass 40 and, therefore, are necessary to assess whether or not students gain new competencies as result of their participation in education and training programs. However, only a few among the selected articles reported performance objectives.
The lack of homogeneity in terms of competency definition and related characteristics—such as performance objectives or specific expected outcome—poses an additional challenge to educational designers in the field of humanitarian assistance and disaster management. A previous study showed, in fact, that only 61% of the educational and training initiatives offered in European countries have a competency-based curriculum design.Reference Ingrassia, Foletti and Djalali 55
Little agreement on the terminology used was also found in the definition of proficiency levels within target groups. In 2011, an internationally accepted framework to define target audiences on the basis of their level of responsibility was developed: strategic-level (gold), tactical-level (silver), and operational (bronze).Reference Wallis and Smith 56 A common terminology, would facilitate the ongoing standardization process in education, certification (among providers), and accreditation (among academic-affiliated education and training institutions) in disaster response and humanitarian assistance.
It is a well-recognized consensus that all the professionals involved in disaster preparedness and response (eg, search and rescue, fire brigades, etc) should receive specific training regardless of the professional sector to which they belong.Reference Ingrassia, Foletti and Djalali 55
However, even if this literature review has been conducted through different search engines, including but not limited to medical databases, the vast majority of articles reviewed still reported competencies directed to the health care sector. Accordingly, similar results came from an analysis on training opportunities in mass destruction weapons (CBRNE), including the following professional sectors: general manufacturing, transportation, health care, emergency response, and skilled support.Reference Mitchell, Doyle and Moran 51
As such, this expanded the available competencies and resulted in considerably more training opportunities for health care workers compared to other professional sectors.
It is crucial to underline that while health care plays a relevant role in disaster response, education must also be extended to other actors equally involved in disaster management. Indeed, international standards on education and training in the field for disaster management emphasize that education and training programs should be both multidisciplinary and transdisciplinary and based on a modular approach;Reference Seynaeve, Archer and Fisher 57 this strongly implies that the definition of relevant competencies must first consider the wide audience the education and training might include.
Most articles were nursing-centric. Since September 11, 2001, numerous efforts have been made to enhance preparedness within this specific professional group, as they are early responders to disasters, represent skilled human resources within the health sector, and play active roles in national preparedness plans.Reference Stanley 43 Among the studies that included multidisciplinary competencies, that of the American Medical Association Center for Public Health Preparedness and Disaster Response provides a comprehensive consensus-based set of competencies that integrates all the health specialties involved in disaster medicine and public health.Reference Subbarao, Lyznicki and Hsu 5
Supporting previous research, the majority of the competency sets were based on consensus building.Reference Daily, Padjen and Birnbaum 14 However, surveys have also demonstrated a method to extract competencies, skills, and behaviors based on the opinion and field experience of a number of providers from the target audience. The combination of both methods could provide good evidence on the existing educational gaps from an academic and operational standpoint.
While searching peer-reviewed literature yielded a number of articles, several papers were reports, and others were web-based resources that were not accessible through the search engines utilized. This demonstrates that over the last decade, several competency sets for professionals working in disaster response and humanitarian assistance have been developed; however, some of them remain published as grey literature.
Limitations
This search was restricted to English-language articles, which might have narrowed our search spectrum; however, it is a comprehensive systematic review and covers most of competency-based disaster education and training elements in the studies reviewed.
This study only included articles published over the last decade. Related studies that could have supplied relevant information but fell outside this time period were not taken into consideration.
Even if it would have been useful and of great interest to develop a comprehensive competency framework on the basis of all the competencies provided by the articles reviewed, the huge number of competencies listed—along with the aforementioned lack of standard terminology—made this task difficult if not impossible to accomplish. However, it is hoped that this study will draw attention to the potential causes that currently prevent professionals in disaster medicine and humanitarian action from receiving a standardized and globally recognized education and training opportunities. The authors suggest that more directed research, discussions, and debates on the reasons for these gaps is required before the expected level of professionalism is realized.
Conclusions
This systematic literature review revealed a huge number of competencies published over the last decade for different professional sectors involved in disaster response and humanitarian assistance. Studies reviewed (both peer reviewed and grey literature) were mainly focused on the health care sector and presented a lack of agreement on the terminology used for competency-based definition and phrasing. The most targeted discipline was nursing, and the main method adopted for competency development was consensus building. Further engagement to standardize competency-based education in disaster medicine and humanitarian assistance is needed; the development and validation of a common competency-framework for all the professionals involved in crisis response will represent a decisive step forward for professionalization and certification and will facilitate greater accountability, transparency, and performance oversight.
Acknowledgments
Authors wish to thank all the DITAC Project members for their contribution and assistance in conducting the research activities that allowed us to write this manuscript.
Funding
This research is part of the activities of the Disaster Training Curriculum (DITAC) project funded by the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 285036.
Conflict of Interest
There are no situations which this manuscript that may be perceived as conflict of interest or as a copyright constraint.
