BMC Emerg Med. 2026 Aug 28;26(1):235. doi: 10.1186/s12873-026-01753-y.
ABSTRACT
BACKGROUND: Emergency medical services (EMS) physicians must manage a broad spectrum of high-acuity prehospital emergencies. However, current training pathways in Germany are not explicitly competency-based and provide limited structured exposure to low-frequency, high-stakes scenarios. Entrustable professional activities (EPAs) offer a framework to align training with real-world clinical demands. This study aimed to identify key prehospital tasks suitable for an EPA-based curriculum.
METHODS: We conducted a multi-method descriptive study combining (1) a retrospective analysis of 4,078 prehospital EMS physician records (Nuremberg, 2017-2021) to assess case-mix and procedural frequencies and (2) an online survey of 134 bavarian EMS physicians assessing self-reported confidence across emergency domains. Tasks were categorized on the basis of frequency and confidence levels and mapped to candidate EPAs.
RESULTS: Nontraumatic emergencies were dominated by cardiovascular and neurological conditions, whereas traumatic cases involved primarily extremity injuries. The most frequent interventions were intravenous access, oxygen administration, and ECG acquisition; invasive procedures were rare. Physicians self-reported high perceived confidence in resuscitation, airway management, and analgesia and lower perceived confidence in paediatric, neonatal, obstetric, and mass-casualty scenarios. Physicians with an anaesthesiology background descriptively reported higher perceived confidence across several domains; no inferential testing was performed. Tasks characterized by either high frequency with low confidence or low frequency with high stakes were identified as key targets for EPA development.
CONCLUSION: These findings identify patterns of clinical exposure and self-perceived confidence in the studied EMS context and suggest domains that may warrant further investigation in broader settings. They may inform the preliminary development of candidate EPA-based training frameworks in physician-staffed EMS systems. However, the findings do not demonstrate actual competence deficits, unsafe practices, patient safety effects, or the effectiveness of EPA-based curricula.
CLINICAL TRIAL NUMBER: Not applicable.
PMID:42681606 | DOI:10.1186/s12873-026-01753-y
