The article “What Kinds of Skills are Necessary for Physicians Involved in International Disaster Response?” by Noguchi et alReference Daily ¹ addresses an important issue, particularly as competencies become cornerstones of disaster educational programs. Knowing what specific skills are utilized frequently by disaster responders is key to formulating the competencies to direct appropriate education. I laud the authors for undertaking this inquiry. However, I have some concerns with their methodology as well as their interpretation of results and consequent conclusions.

First of all, although supposedly addressing and evaluating the frequency of performance of the primary skills required for physicians responding to disaster, the survey items were based on nursing skills published in the nursing literature, as well as skills incorporated in the multi-disciplinary Japan Medical Team for Disaster Relief training curriculum. And, indeed, many of the 42 “skills” included in the survey appear more relative to nurses than physicians; although in times of crisis, there is much overlay and parameters become less rigid. Additionally, as no open-ended questions were included in the survey, it is unknown what skills other than the 42 listed might have been performed, or their frequency of performance. I would also argue that the 42 “skills” listed are not actual skills, but rather, activities or arenas of action that require numerous skill sets. Likewise, the authors’ categorization of “skills” is open to some question. For example, neither wound irrigation nor the application of a medical dressing are uniquely surgical skills.

The reported finding that “the mean surgical skills score was the highest among all the post-disaster phases” does not appear to be borne out by the data in the table of ranked skills that lists only one surgical skill (wound irrigation or assistance with wound irrigation) in the top 23 skills that were performed “sometimes,” “often,” or “always.” To conclude that “this finding indicates that physicians who participate in international disaster relief need to prepare for surgical procedures” is not supported by the evidence provided.

Finally, the conclusion that “the findings of this study elucidate the primary skill needed for international disaster-relief physicians” is difficult to support as this was not assessed in the study. Although the frequency of some activities or areas of activities in which disaster-relief physicians were involved was enumerated, we are a far cry from articulating an evidence-based set of skills or competencies for disaster-relief physicians or other health care providers.

However, I laud the authors for exploring this important area of study. The disaster health care world is in desperate need of gathering evidence on the functions and skills actually utilized in response efforts. Because we lack such important information, competency-based education remains mired in expert opinions, of which there are many.

I encourage the authors, as well as other investigators, to continue to pursue information that will better inform the development of appropriate competency-based education.