title: Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.
abstract: BACKGROUND
  Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training.
  
  
  METHODS
  This qualitative study was performed in 2013. A questionnaire-based evaluation of experts' opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data.
  
  
  RESULTS
  This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters.
  
  
  CONCLUSIONS
  The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always provide expected capabilities and services. Failures in leadership and in coordination among teams are also a problem. All deficiencies need to be applied to competency-based curricula.
authors.affiliation: 1CRIMEDIM,Università del Piemonte Orientale,Novara,Italy.
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Djalali
authors.affiliation: 1CRIMEDIM,Università del Piemonte Orientale,Novara,Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Ingrassia
authors.affiliation: 1CRIMEDIM,Università del Piemonte Orientale,Novara,Italy.
authors.forename: Francesco Della
authors.initials: FD
authors.lastname: Corte
authors.affiliation: 1CRIMEDIM,Università del Piemonte Orientale,Novara,Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Foletti
authors.affiliation: 1CRIMEDIM,Università del Piemonte Orientale,Novara,Italy.
authors.forename: Alba Ripoll
authors.initials: AR
authors.lastname: Gallardo
authors.affiliation: 1CRIMEDIM,Università del Piemonte Orientale,Novara,Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ragazzoni
authors.affiliation: 2Disaster Research Center (AFAM),Istanbul Aydin University,Istanbul,Turkey.
authors.forename: Kubilay
authors.initials: K
authors.lastname: Kaptan
authors.affiliation: 3URGENTA,Clinical Emergency Hospital,Bucharest,Romania.
authors.forename: Olivera
authors.initials: O
authors.lastname: Lupescu
authors.affiliation: 4Hanover Associates,Teddington,London,United kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Arculeo
authors.affiliation: 5NHCS,National Health Career School of Management,Hennigsdorf/Berlin,Germany.
authors.forename: Gotz
authors.initials: G
authors.lastname: von Arnim
authors.affiliation: 5NHCS,National Health Career School of Management,Hennigsdorf/Berlin,Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Friedl
authors.affiliation: 6Bonn International Center for Conversion,Bonn,Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ashkenazi
authors.affiliation: 7University Clinic Bonn Department of Orthopedics and Trauma Surgery,Germany.
authors.forename: Deike
authors.initials: D
authors.lastname: Heselmann
authors.affiliation: 8CROUMSA,Croatian Urgent Medicine and Surgery Association,Slav. Brod,Croatia.
authors.forename: Boris
authors.initials: B
authors.lastname: Hreckovski
authors.forename: Amir
authors.initials: A
authors.lastname: Khorram-Manesh
authors.affiliation: 9Prehospital and Disaster Medicine Centre,Sahlgrenska Academy,Gothenburg,Sweden.
authors.forename: Amir
authors.initials: A
authors.lastname: Khorrram-Manesh
authors.affiliation: 10SBC,General &Teaching Hospital Celje, Medical Faculty Ljubljana,Slovenia.
authors.forename: Radko
authors.initials: R
authors.lastname: Komadina
authors.affiliation: 11German Aerospace Center (DLR),Oberpfaffenhofen,Germany.
authors.forename: Kostanze
authors.initials: K
authors.lastname: Lechner
authors.affiliation: 12Clinical Emergency Hospital Bucharest,Romania.
authors.forename: Cristina
authors.initials: C
authors.lastname: Patru
authors.affiliation: 13Harvard Humanitarian Initiative,Cambridge,MassachusettsUSA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Burkle
authors.affiliation: 7University Clinic Bonn Department of Orthopedics and Trauma Surgery,Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Fisher
mesh_terms: D003162:Competency-Based Education; D054597:Disaster Medicine / Q000193:education*; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D007391:International Cooperation; D007857:Leadership; D010348:Patient Care Team / Q000458:organization & administration*; D011361:Professional Competence; D036301:Qualitative Research; D011795:Surveys and Questionnaires