An analysis of educational needs to enhance the response competency of infectious disease control personnel to emerging infectious diseases

Abstract

Purpose

This study aimed to explore the training experiences and educational needs of personnel working at nationally designated infectious disease control institutions in South Korea. Specifically, it sought to identify the barriers encountered in infectious disease response, assess the perceived effectiveness of current training programs, and determine key competencies and tailored educational needs across occupational groups.

Methods

A qualitative study was conducted using focus group interviews with 34 participants, including healthcare and nonhealthcare personnel engaged in infectious disease control. Participants were recruited through snowball sampling. Data was collected over 5 weeks via online interviews, transcribed verbatim, and analyzed using qualitative content analysis. Investigator triangulation and member checking were used to enhance the analytical rigor.

Results

The participants reported that the current training program contributed to improved confidence, role clarity, and interdepartmental collaboration. However, multiple barriers were identified, including a lack of standardized scenarios, insufficient hands-on training, unclear guidelines, and low accessibility across roles. Key educational needs included scenario-based simulations, job-specific content, advanced clinical skills, psychological support, and interorganizational collaboration. Training preferences varied by job category, underscoring the need for differentiated role-based training modules.

Conclusion

These findings highlight the importance of shifting from theory-based to practice-oriented education on infectious disease responses. To build sustainable preparedness systems, training programs should be scenario-driven, repetitive, and psychologically supportive. Institutional policies must ensure flexibility, equity of access, and proper incentives for participation. Future efforts should prioritize the development of standardized competency-based curricula tailored to diverse occupational roles within infectious disease response systems.

Introduction

Over the past 3 decades, humanity has faced unprecedented challenges from infectious diseases, including severe acute respiratory syndrome (SARS), influenza A virus subtype H1N1, Middle East respiratory syndrome (MERS), Ebola virus disease, Zika virus disease, and, most notably, coronavirus disease 2019 (COVID-19). The global spread of COVID-19 in particular led to significant loss of life and economic disruption, underscoring the ongoing risk posed by such diseases. More recently, the monkeypox outbreak in 2022 demonstrated the increasingly unpredictable nature of global infectious threats. Over the past 3 decades, these major outbreaks have demonstrated that humanity remains persistently exposed to the risk of unpredictable and potentially devastating infectious diseases, highlighting the necessity for thorough preparedness and robust international collaboration [1].

In South Korea, one national infectious disease specialist hospital and five regional infectious disease hospitals, and 38 nationally designated isolation and treatment facilities have been established to respond to such crises [2,3]. Notably, the nationally designated isolation and treatment facilities, as key institutions for infectious disease control, are medical institutions equipped with specialized infrastructure and equipment within segregated areas to isolate and treat patients with emerging infectious diseases during public health emergencies, thereby preventing further transmission [4]. These facilities have been established and operated since 2006, and, since 2017, annual evaluations of their infrastructure, workforce, and operational systems have been conducted to strengthen their infectious disease emergency response capabilities [5]. In accordance with operational and management guidelines, all 38 institutions must provide at least one annual training session on infection control to their operational teams caring for infectious disease patients [3] and are mandated to offer regular education and training to healthcare personnel and public health workers in close contact with these patients [6].

The most effective approach to infectious disease response is to enhance the infection control competencies of the personnel involved in such efforts, making education and training essential components of preparedness [7]. Since the onset of the COVID-19 pandemic, the importance of infectious disease response has become increasingly prominent, highlighting the need for systematic and tailored training programs [8-10]. In medical and health professions education, infectious disease outbreaks and pandemics have reinforced the need for structured preparedness training, including infection prevention and control, risk communication, and teamwork competencies. Systematic and scoping reviews show that educational interventions can improve learners’ knowledge, skills and attitudes, but also highlight gaps in evaluation quality and consistency across contexts [11]. However, much of the published work has focused on students or single professional groups, while less is known about role-differentiated training needs across the multidisciplinary workforce in high-consequence setting such as designed infectious disease institutions [12]. Accordingly, a needs assessment grounded in frontline experience is necessary to inform competency-based, interprofessional training design and institutional support strategies.

Current training programs primarily target physicians and nurses, often neglecting other essential personnel such as transport staff, environmental services, and administrative teams. Additionally, these programs tend to focus on theoretical knowledge and basic infection protocols, with limited emphasis on hands-on experience, role-specific competencies, or real-world application. As a result, many frontline workers feel unprepared to respond effectively during outbreaks [13].

In response to this need, the National Medical Center conducted a series of surveys in 2023, including the “Survey on the educational and training needs for emerging infectious disease response personnel [14],” the “Survey on the current status of emerging infectious disease response personnel and education/training supply [15],” and the “Survey of training providers related to emerging infectious diseases [16].” The resulting reports analyzed the current status and structure of infectious disease response training systems in Korea, identified challenges, and proposed areas for improvement. Notably, the findings revealed that most existing education and training programs are primarily directed at specialized healthcare professionals, such as physicians and nurses. These surveys showed that existing guidelines are difficult to interpret and apply in practice, and that most training content does not reflect the actual responsibilities of diverse occupational groups involved in infectious disease control.

Given the gaps, this study aims to explore the real-world training experiences and educational needs of personnel working in Korea’s nationally designated infections disease institutions. By focusing on both healthcare and non-healthcare workers, the study seeks to understand common challenges, assess the effectiveness of existing training, and identify key competencies needed for field readiness. To gather in-depth insights, the research team employed qualitative focus group interviews (FGIs). This approach was chosen for its ability to capture detailed personal experiences and to foster discussion among individuals in similar roles. The study ultimately aims to generate practical recommendations for improving the structure and delivery of training programs, moving from generalized education toward differentiated, scenario-based learning that reflects the complexity of infectious disease response environments.

This study aimed to explore the following research questions: (1) What are the experiences of personnel at infectious disease control institutions (i.e., nationally designated isolation and treatment facilities) regarding education and training for infectious disease response? (2) What are the barriers faced by these personnel during infectious disease responses and in the process of participating in infectious disease training? (3) What are the perceived outcomes of infectious disease response training, and what are the key competencies required in the field? (4) What are the specific educational and training needs necessary to support effective field performance and strengthen response capabilities?

Methods

1. Ethics statement

This study was approved by the Institutional Review Board (IRB) of Konyang University (IRB no., KYU 2024-09-007). All participants were fully informed about the study’s purpose, procedures, risks, benefits, and data confidentiality, and provided written consent before participation.

2. Participants

A total of 34 individuals were recruited via snowball sampling, based on referrals from infection control professionals at nationally designated infectious disease institutions or related oversight agencies, who had participated in or supported infectious disease response and/or related training, were able to join an online FGI in Korean, and provided informed consent. Given the exploratory qualitative design, our aim was maximum variation rather than statistical representativeness; recruitment continued until thematic saturation was reached within the major occupational groups. The sample included 16 healthcare workers (physicians and nurses), 15 administrative staff members (specializing in patient transport, environmental services, or facility management), and three government officials involved in institutional oversight. Government officials were included as key informants to complement the field perspectives, and findings were interpreted with caution to avoid overgeneralization to this subgroup.

3. Research instruments

To conduct the FGI, a semi-structured interview guide was developed in three steps [17]. First, the research team reviewed relevant literature and guidelines on infectious disease response and personal competencies [18-25]. Second, a panel of three experts including infectious disease and education specialists validated the preliminary questions for clarity and relevance. Third, a pilot interview tested the flow and clarity of questions. The finalized guide covered three main domains: (1) training experiences and challenges in practice, (2) required field competencies, and (3) educational needs by occupational group. Questions were tailored to each participant’s role, with flexibility during interviews to adapt to emerging themes.

4. Data collection

Data was collected over 5 weeks from September 19 to October 21, 2024, via Zoom interview (Zoom Video Communications Inc., San Jose, USA). Each session included a lead interviewer and two assistant moderators. Sessions averaged 2 hours, and interviews continued until thematic saturation was reached. All sessions were video recorded with consent. Researchers also took notes on nonverbal cues and contextual elements. After each interview, key discussion points were shared with the participants for verification, and each participant received a nominal honorarium.

5. Data analysis

Data was analyzed using qualitative content analysis methodology proposed by White and Marsh [26] in 2006 to systematically analyze the FGI data. In line with directed/deductive content analysis, we first developed an initial coding frame (categorization matrix) based on the study aims and the three domains of the semi-structured interview guide, which were informed by prior literature and guidelines on infectious disease response training and competencies [27,28]. The a priori frame covered: (1) training experiences and perceived outcomes, (2) barriers/challenges in training and response, and (3) role-based competencies and educational needs. Transcripts were analyzed as the unit of analysis, and meaning units were coded and condensed into categories and themes. Three researchers independently conducted open coding within the initial frame, and inductive codes were added when data did not fit pre-existing categories. Through regular analytic meetings, we refined code definitions, resolved discrepancies, and iteratively revised the coding frame until consensus was reached. Member checking was used to enhance credibility by sharing key interpretations with participants.

Results

Based on the qualitative content analysis, findings were organized into overarching categories and subcategories aligned with the coding frame, with inductive codes added when data did not fit the initial matrix. Each subsection below reports categories/subcategories and is illustrated with representative quotations, while detailed category matrices are provided in the corresponding tables.

1. Demographic characteristics of participants

FGIs were conducted with 34 participants, of whom 20 were women (58.8%) and 14 were men (41.2%). The participant cohort was predominantly composed of individuals in their 40s (n=17; 50.0%) and 50s (n=13; 38.2%). The mean age was 47.4±6.8 years. The average professional experience was 18.4±7.2 years, with half of the participants having worked in their field for over 2 decades (Table 1).

Table 1.

Demographic Characteristics of Participants

Affiliated healthcare institutions	Major university hospitals	General hospital	National/local government agencies	Total
Occupational groups
Medical doctor	4 (11.8)	1 (2.9)	0 (0.0)	5 (14.7)
Infection control nurse	6 (17.6)	0 (0.0)	0 (0.0)	6 (17.6)
Nurse	5 (14.7)	3 (8.8)	0 (0.0)	8 (23.5)
Transport personnel	2 (5.9)	0 (0.0)	0 (0.0)	2 (5.9)
Administrative staff	6 (17.6)	1 (2.9)	0 (0.0)	7 (20.6)
Environmental services personnel	2 (5.9)	1 (2.9)	0 (0.0)	3 (8.8)
Local government officials	0 (0.0)	0 (0.0)	3 (8.8)	3 (8.8)
Total	25 (73.5)	6 (17.6)	3 (8.8)	34 (100.0)

Data are presented as number (%).

2. Experiences of education and training for infectious disease response

Using qualitative content analysis, we identified three categories with subcategories regarding education and training experiences: (1) training providers and participation pathways, (2) training content and duration, and (3) perceived educational outcomes.

Participants received training from their own healthcare institutions as well as external organizations, including the National Medical Center, major university hospitals, academic societies and associations, and public agencies. Access to these programs was facilitated through official announcements, work assignments, voluntary participation, and institutional recommendations. Instructional methods were primarily practice-oriented, featuring simulations, mock drills, case-based learning, and hands-on sessions, which participants found highly applicable to real-world scenarios. Training duration varied, categorized as short-term (1–4 hours), medium-term (4–8 hours), or long-term (8–16 hours). Core training content covered a comprehensive range of topics, including patient triage, infection control principles, proper use of personal protective equipment (PPE), environmental disinfection, crisis communication, and the management of vaccines and specimens.

The training programs produced meaningful impacts at both organizational and individual levels. Organizationally, the training contributed to the validation of infectious disease response protocols, strengthen interdepartmental collaboration, and the establishment of safer working environments. Individually, participants reported improved response competencies, enhanced professional knowledge, greater psychological stability, and the development of innovative perspectives on infectious disease management.

3. Barriers to education and training

Barriers to education and training were coded into key categories and subcategories (Table 2), including (1) operational constraints (e.g., limited time/resources and low participation) and (2) competency-related gaps.

Table 2.

Barriers to Infectious Disease Response Education and Training

Main category	Subcategory	Code	Specific content
Challenges in program operations	Barriers to education and program	Limited availability of training time	Difficulty providing additional training beyond mandatory hours; difficulty attending training due to shift work; limited training opportunities for core response personnel
		Lack of education	Lack of education and job performance challenges for newly hired staff; lack of critical nursing education; limited training opportunities
		Superficial training content	Repetitive content in training on treatment beds facilities; overly formalistic training content requiring improvement
		Low staff participation in training	Difficulty in voluntary staff participation; limited participation of staff from multiple departments in simulation and tabletop training
		Cost of training materials	High cost of tabletop training tools
	Barriers to training participation	Lack of knowledge	Lack of staff knowledge in environmental management; burden on facility staff due to contractors’ lack of expertise in isolation room design; limited capacity to conduct simulation training due to insufficient understanding of conditions in long-term care hospitals
		Insufficient capacity	Uncertainty in infection diagnosis; challenge in defining the scope of exposure investigations, insufficient capacity to design learner-centered training; limited capacity to plan and implement simulation training; limitations in scenario development; challenges in coordinating roles across institutions and occupations in infectious disease response training; operational challenges related to negative pressure carts; management of invasive medical devices; operational complexity of maintaining seals and specialized equipment; limited adaptability to training among older staff

Key operational challenges include limited training time, inadequate content quality, low participation rates, and resource constraints. Participants emphasized that time pressures often restricted training to legally mandated minimums, which limited opportunities for core personnel and left new or critical care staff with insufficient education. A common perception was that training content was often superficial or overly formalistic.

• “Only staff in the infectious diseases department and the infection control unit are required to complete 8 hours of mandatory training. For other occupational groups, it is just an hour. That is actually difficult… Staff members with less experience are the ones who really need this training. But ironically, we do not have a clear justification to require those with less knowledge to participate in the full 8-hour program.” (Infection control nurse 3)

• “I attend seminars or training sessions about once a year, but honestly, they are more like formal seminars rather than genuine continuing education… When I look at the training we receive, it often feels a bit amateurish.” (Administrative staff 5)

From the participants’ perspective, significant gaps in knowledge and competencies emerged as further barriers. These included deficits in environmental management and facility design, a limited understanding of the unique conditions within long-term care hospitals, and an insufficient capacity to develop and conduct effective, learner-centered simulation training. Competency-related barriers included uncertainty in infection diagnosis, difficulties in defining the scope of exposure investigations, operational challenges with specialized equipment and difficulties in mastering skills required for high-risk populations.

• “The biggest challenge I had with environmental management was training staff who had no foundational knowledge. Ideally, they should already have a basic understanding before the training. That way, they could better grasp how environmental management should be done. But that was not the case, and it made the training very difficult.” (Nurse 5)

4. Challenges to infectious disease response

Using qualitative content analysis, challenges encountered during infectious disease response were coded into six categories: (1) staff shortages, (2) lack of guidelines and information, (3) difficulties in psychological and safety management, (4) work environment challenges, (5) inadequate compensation and motivation, and (6) challenges specific to COVID-19 response (Table 3).

Table 3.

Challenges Encountered during the Infectious Disease Response

Main category	Subcategory	Code	Specific content
Challenges in infection control	Staff shortage	High turnover and staff transfers	Burden of training inexperienced staff and managing isolation beds due to rotation of experienced personnel; challenges in repetitive infection control training due to high turnover of support personnel
		Staff-shortage	Shortage of nursing staff for critically ill patients; critical care burden on general nurses; lack of personnel support during pandemics; nursing staff allocation challenges during emergencies
		Communication barriers	Communication barriers between departments; interdepartmental collaboration challenges during inpatient care
	Lack of clear guidelines and up-to date information	Lack of clear guidelines	Operational difficulties due to insufficient detail in national guidelines for managing designated treatment beds; difficulties managing staff from other departments due to lack of detailed guidelines
		Lack of up-to date information	Difficulties in persuading other clinical departments due to lack of information on emerging infectious disease
		Difficulty applying guidelines in real-world setting	Divergent interpretations of guidelines within department
	Psychological and collaborative difficulties	Lack of awareness	Management challenges due to subcontracted workers’ low risk awareness when replacing contaminated filters
		Fear	Fear due to lack knowledge and experience in infectious disease response, Hesitation to participate in infectious disease response due to fear among healthcare and non-healthcare personnel
		Risk of infection exposure	Exposure to infection risk due to improper PPE use during emergency situations
		Lack of patient cooperation	Lack of patient cooperation during transport
	Work environment challenges	Excessive workload	Decision-making burden; difficulty persuading leadership to approve staffing, equipment purchases, and ER closure during infectious responses; difficulty applying government guidelines to hospital settings; difficulty applying theoretical knowledge to real-world practice
			Burnout caused repeated PPE donning and doffing training for large numbers of staff during the COVID-19 pandemic; difficulty preparing environmental cleaning supplies; discomfort and time burden caused by wearing PPE during environmental cleaning
			Increased tie burden of cleaning isolation; challenges in operating hospital isolation beds and managing on-call standby duties; physical fatigue and discomfort caused by wearing PPE; physical fatigue and intensified workload caused by PPE use; handling difficulties due to triple packaging during specimen transport
		Unclear division of responsibilities	Unclear division of responsibilities during infectious disease response
		Shortage of facilities for infectious disease response	Shortage of specialized beds for COVID-19 patients with advanced care needs; shortages in facilities and personnel for infectious disease management
		Facility operation	Maintenance challenges of aging negative-pressure isolation beds; operational challenges due to energy loss and condensation in air systems for negative-pressure isolation rooms
		Supply management	Supply and logistics management of infection prevention materials
	Lack of motivation	Lack of compensation	Disparities in compensation by job category for COVID-19 ward duties; lack of compensation for infectious disease response; lack of compensation for retaining infectious disease response personnel; lack of compensation for completing infectious disease response training

PPE: Personal protective equipment, ER: Emergency room, COVID-19: Coronavirus disease 2019.

Staffing issues included not only a shortage of experienced professionals but also high turnover rates and difficulties in securing support personnel from other departments. Regarding guidelines, participants reported that national protocols lacked sufficient detail and that applying general guidance to specific clinical settings was challenging. Psychological and safety barriers included difficulties managing externally dispatched personnel, heightened anxiety and stress due to a lack of prior outbreak experience, and persistent concerns over infection risk.

• “When a suspected patient arrived, the nurse on duty that day… had almost no experience with Level C protective equipment. They did not feel confident, so a head nurse from another unit had to be urgently called in… That experience made us realize the importance of ongoing training… Maintaining experienced personnel is probably the most difficult challenge we face.” (Infectious disease physician 4)

• “There needs to be a clearer plan for staff allocation, working hours, and personnel support for the infection control unit—not just during pandemics, but during regular times as well. But that is still really lacking.” (Infection control nurse 1)

Work environment challenges included excessive workloads leading to burnout and an unclear division of responsibilities. In terms of compensation, participants cited a lack of adequate hazard pay and reward systems for high-risk duties as well as insufficient access to training opportunities. During the COVID-19 response, specific obstacles emerged, such as initial confusion, deficient patient triage and transport systems, and shortages of dedicated facilities and personnel.

• “Even when we give all the necessary warnings, the subcontracted workers do not take the danger seriously when replacing contaminated filters… Managing this kind of situation is difficult for us.” (Administrative staff 4)

• “People who are not familiar with negative pressure systems tend to be very afraid… Our facility staff were terrified when they had to enter the MERS ward to fix a broken door or faucet. They really hesitated.” (Administrative staff 1)

• “The management of protective equipment has become overwhelming. At one point, we were operating up to 64 beds for moderately to severely ill patients. As a regional hub hospital, we were flooded with patients.” (Infection control nurse 3)

• “The budget covers... attending academic conferences. But there is no room in the budget to offer any kind of reward or incentive to the trainees for participating in these trainings.” (Infectious disease physician 4)

5. Perceived effectiveness and required competencies

Qualitative content analysis identified key categories related to (1) perceived training effectiveness and (2) required competencies for infectious disease responses (Table 4).

Table 4.

Perceived Effectiveness of Training and Required Competencies for Infectious Disease Responses

Main category	Subcategory	Code	Specific content
Effectiveness of infectious disease response training	Organizational level	Review of procedures and systems	Implementation of patient transport procedures between medical institutions within the same administrative region; review of response manuals
		Understanding of policies and response systems	Comprehension of national infectious disease policies and systems
		Creation of a safer healthcare environment	Establishment of infectious disease response collaboration systems and safety facilities
	Individual level	Enhancement of individual competencies and psychological stability	Increased awareness of infectious disease response; increased confidence in infectious disease response procedures, Increased confidence in wearing personal protective equipment; sense of pride as an infectious disease response worker; reduction of fear during infectious disease response; overcoming fear of infectious diseases
		Improvement and evaluation of work processes	Evaluation and improvement of work procedures
		Collaboration and mutual understanding between departments and institutions	Understanding of roles across occupations and institutions; understanding of roles across occupations and institutions; sharing of case-based information from other hospitals
		Acquisition of new perspectives and ideas	Acquisition of new perspectives through diverse opinions
Required competencies for infectious disease response	Problem-solving and adaptive response capabilities	Problem-solving and adaptive response capabilities	Response competency for incoming infectious disease cases
			Ability to solve problems under unexpected or crisis conditions
			Competency in managing critically ill patients
			Critical care nursing competency
	Emotional and social competencies	Communication and leadership competencies	Communication competencies
			Leadership
		Professional identity and self-efficacy in infectious disease response	Professional pride among hospital staff
			Self-protection and confidence in emerging infectious disease response

Training was perceived as effective at both the organizational and individual levels. Organizationally, it was seen as vital for establishing and evaluating cooperative response systems, enhancing understanding of national policies, and creating a safer healthcare environment. Individually, participants reported increased confidence in their response capabilities, improved work performance, and stronger collaboration.

Based on their experiences, participants identified several key competencies for effective response: problem-solving and adaptive capabilities, effective communication and leadership, and a strong sense of professional identity and self-efficacy. They particularly highlighted the ability to respond promptly to emerging cases, solve problems in crisis situations, provide appropriate care for critically ill patients, ensure self-protection and psychological stability, and maintain seamless communication across departments.

• “We monitored the entire process… At each step, we identified what was lacking and what needed improvement… That session allowed us to understand not only our roles but also the roles of other departments. Through the simulation, I was able to experience how these efforts come together to create a safer hospital environment.” (Infectious disease physician 2)

• “Ultimately, experience is the most important competency… Without experience, people hesitate and feel afraid. But during the prolonged COVID-19 outbreak, we encountered so many new scenarios—testing, procedures, surgeries, childbirth, transfers, and even deaths… and it really made a difference.” (Infection control nurse 3)

• “Since we are not a tertiary hospital, our ability to care for critically ill patients was quite limited. Unlike larger hospitals, we could not operate extracorporeal membrane oxygenation systems smoothly… I think we definitely need to build that capacity.” (Infectious disease physician 3)

• “One program that stayed with me was the mock emergency drill at the National Medical Center, where we had to wear PPE and respond to a simulated emergency. Repeating the donning and doffing helped reduce my anxiety little by little.” (Infection control nurse)

• “There are many situations where you need to take initiative, get other departments involved, and show leadership... I think the training would be much more effective if it incorporated leadership skills and strategies for engaging other departments.” (Infection control nurse)

6. Educational needs for infectious disease response

Using qualitative content analysis, educational needs for infectious disease response were coded into five categories: (1) training methods, (2) content, (3) objectives, (4) institutional and policy support, and (5) other specific requirements (Table 5).

Table 5.

Identified Educational and Training Needs for Infectious Disease Responses

Main category	Subcategory	Code	Target audience
Training methods	Scenario- and situation-based learning	Simulations for various infectious disease scenarios; joint training across occupational groups	Infection control personnel; physicians and nursing personnel; administrative support personnel
	Practice-oriented and implementation-focused training	Protocol-based simulation training for infectious disease response; hands-on training in donning and doffing PPE	All occupational groups
	Regular and repetitive training	Regular refresher training, Repetitive training	All occupational groups
	Tailored and collaboration-centered training	Tailored training by occupational role; collaborative workshops with related institutions	Infection control personnel; physicians and nursing personnel
	Video-based and field-based training	Demonstration video for equipment use; site visits	All occupational groups
Training content	Theoretical knowledge and procedures for infectious disease response	Understanding of infectious diseases; response principles; response procedures for notifiable infectious diseases	All occupational groups
	Clinical practice for infectious disease patients	Emergency and critical care nursing; nursing care for surgical and dialysis patients; nursing care for testing and procedures	Physicians and nursing personnel
	Training in the use of PPE	Selection of PPE; PPE donating and doffing training; fit test	All occupational groups
	Communication and crisis response	Crisis communication; interdepartmental collaboration	Infection control personnel; physicians and nursing personnel; administrative support personnel
	Epidemiological investigation and data analysis	Epidemiological investigation methodologies; data analysis and report writing	Infection control personnel
	Sharing of case experiences and response management from other institutions	Case-based learning from other institutions’ infectious disease response	Infection control personnel
Training effectiveness and objectives	Fear reduction and psychological stability	Anxiety reduction during infectious disease response; increased self-efficacy	All occupational groups
	Problem-solving and adaptive response capabilities	Crisis response capabilities; enhanced capacity to manage critically ill patients	Infection control personnel; physicians and nursing personnel
	Fostering professional identity and leadership	Strengthening professional identity as infection control professionals	Infection control personnel
Educational support systems and policies	Encouraging participation and strengthening incentives	Recognition and rewards for training completion; supporting voluntary participation; official recognition of job roles	Infection control personnel; physicians and nursing personnel
	Development of educational materials and systems	Development of standardized training scenarios; support for the production of demonstration videos	Infection control personnel
	Task coordination and institutional role distribution	Role distribution among hospitals during epidemics; securing work hours for training	Local government; physicians and nursing personnel
Other specific needs	Specialized training on ventilation systems and equipment	Training on dedicated outdoor air system; training on the replacement and management of negative pressure filters	Administrative support personnel
	Equipment operation training	Negative pressure carts; HVAC equipment; hands-on training for operating specialized medical and isolation equipment	Infection control personnel; physicians and nursing personnel

PPE: Personal protective equipment, HVAC: Heating, ventilation, and air conditioning.

Regarding training methods, participants prioritized scenario-based clinical simulations, evidence-based hands-on training, repeated drills of core procedures, job-specific education, and collaborative workshops with external institutions. They emphasized the need for training on equipment operation and protocol-based practical exercises tailored to specific patients, such as surgery or dialysis.

• “To provide diverse experiences, managing PPE and similar equipment is essential... I think it is also important to diversify the training scenarios. By sharing different scenarios and engaging in varied training activities, we can prepare more actively and effectively.” (Infection control nurse 3)

• “We really wish there were more training materials. We are now trying to create some ourselves. But there is a need for things like actual demonstration videos—especially ones that show how to care for patients in isolation.” (Nurse 2)

In terms of training content, key needs included mastery of appropriate PPE use, crisis communication strategies, interdepartmental collaboration systems, epidemiological investigation methods, data analysis skills. Learning from the infection control practices of advanced healthcare institutions through case studies was also highly requested.

• “When a patient with an emerging infectious disease is readmitted, you do not really know what condition they will be in… I realized that advanced nursing skills—up to the level of critical care—are also essential for treating such patients.” (Infection control nurse 6)

• “I would like to receive training on crisis communication and epidemiological investigation techniques. Ideally, something equivalent to the training that official epidemiological investigators receive would be really helpful.” (Infection control nurse 2)

• “I think it would be more useful if there were a collection of standardized, case-based training scenarios—maybe gathered from different hospitals—that we could adapt… I would like to receive training based on that kind of material.” (Infection control nurse 2)

Concerning training objectives, participants emphasized a need for programs that reduce anxiety, strengthen crisis response capabilities, and build professional expertise in managing critically ill patients. They also viewed training as a means of establishing their professional identity. The introduction of an incentive system to enhance motivation was also identified as a key requirement.

• “It would be helpful to have training that reduces vague fear and anxiety. It would be reassuring to have clear messaging from each hospital—like, ‘This is the situation, and here is how we respond.’ That kind of program would really help put staff at ease.” (Nurse assistant 1)

• “At first, I was scared. But as I continued to receive training, I became more confident. I have come to understand that if I follow the infection control department’s cleaning protocols… I’ll be safe. That is why I think this training is so important.” (Environmental services staff 2)

Regarding institutional and policy support, the participants identified the need for standardized training scenarios, support for producing multimedia educational materials, and the establishment of inter-institutional personnel exchange and educational networks. Furthermore, specialized training was requested to improve proficiency with environmental control systems and equipment, such as negative-pressure carts and ventilation systems.

• “I think it would be helpful to have a set of standardized training scenarios that can be shared across institutions… It would be like a scenario bank we could draw from and adapt. That way, the burden of creating everything from scratch would be reduced.” (Infectious disease physician 5)

• “I am in charge of heating, ventilation, and air conditioning (HVAC)… and we are required to take legally mandated training every 2 years. It would be nice to have similarly structured training programs for our field, too. Even something like a certificate of completion… would give us a sense of pride and show that our work is officially recognized.” (Administrative staff 5)

Discussion

This qualitative study explored the training experiences and educational needs of diverse healthcare professionals involved infectious disease response in South Korea. Our findings reveal that educational experiences varied significantly based on the organizing institution, training format, and specific program objectives. From a medical education perspective, this study extends the preparedness-training literature by offering a multidisciplinary, role-sensitive map of barriers, required competencies, and educational needs in designated infectious disease institutions [29]. The categories identified here can be translated into curriculum elements for competency-based and interprofessional continuing professional development, guiding the alignment of learning objectives, instructional strategies, and organizational supports [30]. Importantly, our findings suggest that effective preparedness education should address not only clinical skills but also operational workflow, psychological safety, and cross-role coordination that are often under-specified in traditional clinically oriented training.

The shift from traditional lectures to practical training methods, such as simulations and hands-on drills, was a key theme. Participants affirmed that methods focused on PPE use, patient transport, and crisis communication were highly effective for strengthening real-world responses capabilities. This suggests that conventional, theory-heavy infection control education must be augmented with practice-oriented strategies to be truly effective [9].

However, significant barriers hinder the quality and sustainability of this training. We identified structural constraints on participation, inadequate infrastructure for practical training, challenges in interdisciplinary collaboration, and difficulties in applying guidelines to clinical settings. Obstacles such as conducting joint training across different occupational groups and developing realistic simulation scenarios align with previous research on implementation barriers in infection control education [31]. Furthermore, participants noted a disconnect between some training programs and real-world practice, citing limited time, staff shortages, and unclear guidelines as persistent challenges. These findings underscore the need for strong policy support and institutional frameworks to overcome such barriers.

Previous studies emphasized that outbreak-related training is most effective when it combines clear guidance with practice-based methods, while also noting wide heterogeneity and limitations in implementation and evaluation [29]. In our study, participants’ strong preference for scenario-based, hands-on training aligns with evidence that simulation-based infection prevention and control education can strengthen skills and attitudes, whereas lecture-based approaches mainly reinforce knowledge [30]. The structural barriers reported here, limited protected time, staffing constraints, and difficulties translating guidelines into practice, are also commonly described internationally during viral epidemics [29]. Importantly, our inclusion of non-clinical personnel echoes qualitative work showing that support staff face distinct safety concerns and training needs, underscoring the necessity of role-differentiated, team-based preparedness education [32].

In response to these challenges, participants universally emphasized the need for learner-centered programs. They expressed a strong preference for scenario-based simulation training grounded in realistic settings, opportunities for hands-on practice, and regular, repetitive sessions tailored to their specific roles and work environments.

The study also revealed considerable variability in training needs across occupational groups. Infection control professionals required advanced simulation-based training with standardized scenarios, while nurses prioritized practical training on clinical procedures for critically ill patients. Administrative staff sought training to improve their understanding of hospital systems and facilitate interdepartmental collaboration. This diversity highlights that a “one-size-fits-all” model is ineffective; training must be designed according to the distinct functions and responsibilities of each group [8].

Crucially, participants perceived infectious disease response competency as a multidimensional construct that extended beyond technical skill. They emphasized psychological resilience, collaborative ability, and a strong sense of professional identity as equally important. This indicates that response competency is an integrated concept, combining technical skills with emotional stability, leadership, communication, and professional pride. Consequently, competency models for infection control must incorporate these emotional and social domains alongside clinical skills [9,33]. Training must therefore evolve beyond knowledge instruction to include support for self-efficacy and psychological well-being, while simultaneously strengthening leadership and communication within healthcare teams.

Based on these findings, we propose several recommendations: First, develop job-specific, multidimensional training modules. Curricula should be differentiated for distinct occupational groups and cover a wide range of competencies, from technical knowledge to communication and emotional regulation. Second, expand practice-based and simulation-centered training, institutionalizing methods like tabletop exercises and simulation drills to ensure skills are internalized. Third, provide robust institutional and policy support. This includes guaranteeing protected training time, offering incentives, linking training to career advancement, and fostering inter-hospital collaboration through joint exercises and sharing best practices.

This study has limitations. It was conducted during a period of healthcare labor disputes, which precluded the participation of certain frontline professionals like medical residents, potentially leaving some field-specific needs unaddressed. The uneven distribution across occupational groups, particularly the small number of government officials, may limit transferability of findings for that subgroup. Additionally, its focus on nationally designated treatment institutions means the findings may not be generalized to all healthcare settings.

Despite these limitations, this study provides a meaningful foundation for developing structured, evidence-based training programs. Future research should involve a broader range of occupational groups and employ mixed method approaches with quantitative evaluation indicators to evaluate program effectiveness. Continued exploration into standardized training frameworks tailored to the national disaster response system is also warranted.