A Consensus List of Core Competencies in Emergency Airway Management for Graduating Emergency Physicians: A Modified Delphi Study

Abstract

Study Objective

Emergency airway management (EAM) is a core competency in emergency medicine (EM), yet no standardized national curriculum exists for EM residency training. The Accreditation Council for Graduate Medical Education (ACGME) currently mandates only 35 endotracheal intubations (ETIs) for graduation, which represents a narrow component of EAM. We sought to define a comprehensive, consensus-based list of EAM competencies for all graduating EM residents.

Methods

We conducted a modified Delphi study to identify essential EAM competencies. An initial list of topics was developed through a structured PubMed literature search, review of existing educational frameworks, and input from EM airway educators. Thirteen national experts in emergency airway management and education participated in iterative rounds of electronic surveys to rate and refine proposed competencies. Topics achieving > 80% agreement were included in the final list. Descriptive statistics were used to summarize agreement across rounds.

Results

The first-round survey included 215 proposed topics spanning nine domains: principles of airway management, oxygen delivery, basic airway management, tracheal intubation, pharmacology, pediatric airway management, ventilator management, special clinical circumstances, and education. Consensus was achieved after two Delphi rounds and final included topics were narrowed to 148.

Conclusion

Through a modified Delphi process, we developed a comprehensive, expert-derived list of EAM competencies for EM residency graduates. This framework provides a foundation for standardized, competency-based airway education and assessment in emergency medicine and may reduce variability across residency programs nationally and thus ensure preparedness for independent practice in one of the most critical skill domains in our discipline.